Smoking, Work Stress, and Barriers to Participation in HMO Smoking Cessation Treatment Among Transit Workers: Focus Group Results

Abstract

Elevated smoking prevalence among transit workers suggests that cessation services may not be appropriately tailored to this occupational group, resulting in treatment underutilization. We conducted 11 focus groups with employees (n=71) at a transit agency based in Oakland, California to explore workers' views and experiences regarding perceived barriers to participation in HMO smoking cessation treatment. Key themes that emerged from content analysis of the focus group transcripts included smoking for immediate relief from work stress, concerns about pharmacotherapy side effects, and structural barriers to treatment such as work shift schedules. This information can be used to tailor interventions aimed at effective tobacco cessation efforts with this workforce.

Prevalence and Correlates of Current and Former Smoking among Urban Transit Workers

“…Previous studies among other blue-collar occupational groups, such as building trades apprentices [18] , motor freight workers [19] , and firefighters [20] demonstrate that detailed knowledge of the occupational context and culture of each group is needed in order to design interventions that can effectively reduce tobacco use. Of note, all of the workers in the study have access to health insurance as a transit agency employee benefit [14] . This is important because being uninsured is associated with increased smoking prevalence among working adults [2] .…”

“…Data for this project were collected as part of a mixed-methods study at an Oakland, California-based public transit agency aimed at identifying perceived and structural barriers to transit workers' participation in health-insurance-sponsored cessation treatment. As a formative part of the research, focus groups were conducted among current and former smokers; results on barriers to treatment such as inaccessibility of classes [14] and perceptions that medication assisted therapy bears excessive risks for this population [15] are reported elsewhere. At the outset of the project, the researchers established a Union–Management Advisory Group with transit agency managers and transit union officers in order to get feedback and practical suggestions on all aspects of the project.…”

“…In the context of a workplace-smoking ban, the ability of a smoker to take a break during their shift in order to smoke a cigarette may take on a sense of urgency [13] . This could pose a particular challenge for bus operators who are under time pressure to maintain the schedule in the face of traffic congestion, and do not have regularly scheduled breaks for eating, restroom use, or smoking [14] . We hypothesized that perceived ease of taking a smoking break would be positively associated with smoking status among transit workers.…”

Frequency of job stressors, difficulty unwinding after work, and sleep problems among urban transit operators

“…Second, the sample was obtained from 1 transit agency, which may limit the study's generalizability. Qualitative research findings from studies of transit workers at 2 geographically distinct agencies, however, indicate that themes related to work stress are common among transit operators across jurisdictions (Cunradi et al, 2015;Dobson et al, 2017); this helps mitigate concerns about generalizability. Third, important potential correlates of sleep problems were not included in the study.…”

Factors Associated with Cessation Activities amongst a Multiethnic Sample of Transit Workers

“…For example, transit operators are subject to traffic congestion, inflexible route schedules, limited access to bathrooms breaks, and interactions with hostile or violent passengers (Chen & Cunradi, 2008;Greiner & Krause, 2006). For some workers, smoking is seen as an easily accessible response to stress due to the perceived calming effect of nicotine (Cunradi et al, 2015). These beliefs, in turn, would have a negative effect on readiness to change.…”