Smoking cessation comes to the fore as EHS issue
What one hospital does to help employees quit
Does "employee health" just mean providing protection against potential occupational hazards? Or does it include a broader scope of prevention and health promotion?
The second view took center stage recently as the National Institute on Occupational Safety and Health (NIOSH) sponsored a workshop on smoking in the workplace. The conclusion: Smoking cessation and wellness programs are integral parts of a comprehensive employee health service.
"If you are concerned about the health of employees you can’t ignore smoking [just as] you can’t ignore the hazards in the environment," says Edward Lee Petsonk, MD, senior medical officer in the division of respiratory disease studies at NIOSH in Morgantown, WV.
Smoking is, in fact, directly related to hazards at work. Since smoking weakens the lungs, smokers may be more sensitive to airborne irritants, more likely to develop asthma or bronchitis, and more susceptible to respiratory illnesses, he says.
"Tobacco is clearly a health hazard. But there are also a lot of health hazards from work. Sometimes these work together to add or in some cases multiply the risks to the individual," Petsonk says.
At the same time, stress at work may be one of the triggers that influences some employees to smoke. These interactions between work and smoking make the work site an appropriate place for smoking cessation programs, he says.
"The comprehensive approach is the logical approach and the one that has the greatest opportunity for impact," says Petsonk.
Almost two years ago, HealthEast Care System in St. Paul, MN, made a commitment to that greater definition of employee health. Creating a "smoke-free workplace" became more than a slogan. It’s a mission.
In August, HealthEast opened a new hospital with a completely smoke-free campus. Employees who want to smoke during lunch have to drive across the street from the wooded campus.
"Hospitals generally have a place on their campus for visitors and patients to smoke. Our new hospital is not even going to have a designated area for that," says Ashlee Murray, community health manager at HealthEast, which has four hospitals, as well as clinics, long-term care facilities, and a managed care plan.
The community and employees have been supportive of the smoke-free environment and of HealthEast’s commitment to the overall health of employees, says Murray. But the health system also recognizes the need to provide smoking cessation programs for employees at all sites.
Employees in the HealthEast health plan already pay lower premiums if they are non-smokers. Now, HealthEast is providing a $150 lifetime benefit for smoking cessation. Employees not in the health plan can get referrals, but must pay the entire program cost out of pocket.
Smokers need choices to quit
Quitting smoking is difficult, and even with incentives and work-based programs, success may be slow.
"We really have learned that anyone who is a smoker needs more than one choice of options," says Murray. "They may have tried things in the past."
The HealthEast choices range from discounts on educational materials to referral to a weeklong, intensive residential program. Smokers can sign up for an American Lung Association support group. Or they can receive phone-based counseling through a program called "Free & Clear."
Free & Clear, developed by Group Health Cooperative in Seattle, involves five intensive telephone-based counseling sessions. In the first call, a counselor assesses the smoker’s needs and helps him or her set a quit date. Using a "Quit Kit," they calculate how many cigarettes they are smoking, and begin to wean off the nicotine. Pre-set calls provide follow-up and support. Free & Clear members also have a lifetime access to the "Quit Line," a special smoking cessation hotline.
"It is a very structured process, and it’s scientifically based," says Sara Tifft, MBA, marketing and sales manager for Free & Clear. "It really walks people through a number of steps that are tried and true. Specialists try to work with each person to see what will work for him or her."
Free & Clear has a success rate of about 30% after one year. That is impressive considering that the program doesn’t count someone as a nonsmoker if they had even one puff of a cigarette in the last 30 days — or if they missed their fifth and final telephone counseling session, says Tifft.
Hard as it is for hard-core smokers to change their habits and kick the nicotine addiction, the greatest step may simply be signing up for a smoking cessation program.
Murray has been disappointed by the lack of response to the smoking cessation programs. Many casual smokers may be able to quit easily on their own, leaving the heavy smokers who may have tried and failed. Or they may not yet be ready to quit.
"We’re going to continue to do different promotions throughout the year to get them involved," she says. "I think smoking cessation is a struggle, but it can’t be something we ever give up on."
[Editor’s note: For more information on Free & Clear, visit the Web site, www.freeandclear.org, or call Sara Tifft at (206) 287-4318.]
Bratcher DF, Stover BH, Lane NE, Paul RI. Compliance with national recommendations for tuberculosis screening and immunization of healthcare workers in a children’s hospital. Infect Control Hosp Epidemiol 2000; 21:338-340.
Hospital-based, nonemployee physicians should be included in mandatory immunizations and tuberculosis (TB) screening, researchers at Kosair Children’s Hospital in Louisville, KY, concluded.
A survey of 55 physicians and 351 hospital employees found very different patterns of compliance with national immunization and TB guidelines. Only 40% of physicians reported having an annual TB screening compared to 93% of employees.
"Many states require annual TB screening for health care facility employees, and there are published recommendations and guidelines for TB screening programs to include all health care personnel," the authors note. "Despite these recommendations, physicians have not been included in many hospitals’ employee-health programs, and they fail to have annual TB screening."
The disparity was not as great for immunizations, but lack of compliance was still significant. Eighteen percent of physicians and 14% of employees indicated they had incomplete hepatitis B virus (HBV) status. "One half (five of 10) of physicians reporting an incomplete HBV vaccine series were specialists who regularly performed invasive procedures," the authors noted.
Most physicians indicated they were aware of the national immunization recommendations for health care workers. Why are there gaps in immunization and screening for TB? A moderate to high factor, according to 94% of physicians, is the lack of mandatory participation in an employee health program. Lack of availability of an employee health program was cited as of moderate to high importance by 74% of the physicians.
"We recommend that mandatory immunization and TB screening policies encompass all HCWs, including physicians," the authors concluded. "Compliance with these policies may require enforcement through the credentialing process or through other innovative strategies that circumvent time-constraint issues."
Interestingly, the study found one area in which physicians had a significantly higher rate of immunization than hospital staff: influenza. Some 57% of physicians reported having an influenza immunization compared to 31% of employees. The authors noted that both rates are "alarmingly low," and speculated that the higher rate among physicians may be due to greater awareness of recommendations or less concern about potential side effects or complications from the vaccine.
Page EH, Esswein EJ, Petersen MR, et al. Natural rubber latex: Glove use, sensitization, and airborne and latent dust concentrations at
a Denver hospital. J Occup Environmental Med 2000; 42:613-620.
In response to a confidential employee request, researchers from the National Institute for Occu-pational Safety and Health investigated natural rubber latex allergy among health care workers at a Denver hospital. They tested latex glove users and nonusers for sensitivity, provided questionnaires on common symptoms, and collected air, surface, and air-filter dust samples.
Their finding: "[N]either current nor past occupational use of latex gloves was associated with latex sensitization in this study population."
The study attracted an unusually high level of participation, with 80% participation in nonclinical areas and 86% in the clinical areas. The nonuser group included employees in human resources, finance, marketing, and other administrative areas. The latex users worked in labor and delivery, the emergency department, and the laboratory service. In all, 532 employees participated.
The prevalence of sensitization did not differ significantly among the latex users (6.1%) and nonusers (6.3%). Furthermore, there was no association between the number of gloves worn daily and sensitization — those who wore more than 18 pairs of gloves daily and those who wore no gloves did not have a significantly different risk.
"There was no significant difference in the prevalence of sensitization between those who reported wearing powdered latex gloves and those who reported wearing powder-free latex gloves," the authors wrote.
Link between glove use and other symptoms
However, researchers did find an association between glove use and certain symptoms. Latex glove users were more likely to report rhinoconjunctivitis, hand urticaria, and hand dermatitis. They speculated that glove use may be a "proxy for other workplace exposures that cause allergic or irritant symptoms." They also noted that with only 32 sensitized individuals in the study, there may not have been a large enough sample to associate sensitization with certain health effects. (A significant proportion of those sensitized to latex did not report any symptoms.)
Interestingly, the researchers found greater airborne concentrations of natural rubber latex proteins in the work areas of nonsensitized employees than of sensitized employees. They speculated that the awareness of latex-allergic co-workers could lead to less powdered-glove use and greater housekeeping vigilance in those areas.
The researchers noted that the powder, protein, and allergen levels in gloves have been declining with greater awareness of latex allergy, which could have led to lower airborne concentrations.
While stating that it’s possible that sensitized workers left the workplace, impacting the results, researchers reported that there was no difference in years worked in the department or hospital by latex exposure or latex sensitization status.
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