Barriers to Blue-Collar HMO Smoking Cessation Participation

Investigator: Valerie Yerger, ND
Sponsor: Prevention Research Center

Location(s): United States


Californians who are blue-collar workers continue to smoke at elevated rates relative to white-collar workers. Despite later age of initiation, African Americans have one of the highest smoking rates among California’s diverse populations. Although statewide smoking prevalence has decreased over the last few decades, significant tobacco-related disparities persist among these groups. A particular paradox is that municipal transit operators, a blue-collar occupational group with a large proportion of African Americans, maintain high rates of smoking even though they have access to free or low-cost HMO-based smoking cessation support programs and activities (e.g., nicotine replacement therapy; cessation support groups). While a considerable amount of research has investigated barriers to cessation, little is known about factors that hinder blue-collar workers from participating in free or low-cost smoking cessation support activities that are available through their HMO as an employee benefit.

This proposal seeks to take this research to the next step in order to lay the groundwork for productive tobacco cessation efforts with this blue-collar, largely African American population. The broad, long-term objectives of this study are to identify the extent that aspects of the workplace social environment and structural factors serve as barriers to blue-collar transit worker participation in free or low-cost HMO-based smoking cessation support activities, and to determine how these barriers may be overcome. The study’s two Specific Aims are to: (1) Identify and describe barriers (and potential facilitators) in the workplace social environment to participation of transit workers in free or low-cost HMO-based smoking cessation support activities. Examples of barriers and facilitators are job strain and perceived coworker support for smoking cessation, respectively. (2) Identify and provide understandings of the workplace structural barriers that limit participation of transit workers in free or low-cost HMO-based smoking cessation support activities. Examples of workplace structural barriers are perceived work rules tacitly encouraging smoke breaks and non-standard work schedules (e.g., shift work, split shifts). Secondary Aims are to: (1) Disseminate study findings to key stakeholders, including transit agency officials, transit union leaders, Kaiser Permanente Regional Health Education, California Tobacco Control Program staff and the African American Tobacco Control Leadership Council, and to transit workers using videos starring transit workers in transit employee waiting and meeting areas and web forums; and (2) Lay the groundwork for an intervention aimed at increasing transit worker participation in smoking cessation support activities.

The project will be conducted among municipal transit workers (bus operators and maintenance employees; n=1500) at the Alameda-Contra Costa Transit District (AC Transit), based in Oakland, California. AC Transit is the third largest public bus system in the state. At the outset of the project, a Union-Management Advisory Group will be formed consisting of research staff, transit agency managers, and transit union representatives. The Advisory Group will meet quarterly and guide all aspects of the project. Sorensen and colleagues’ social-contextual model of behavior change offers a theoretical framework for the proposed research. In order to develop a detailed and nuanced understanding of barriers to (and facilitators of) participation in smoking cessation activities among these workers, the study will employ a mixed methods approach, including focus groups of workers, survey data collection, and semi-structured ethnographic interviews of key informants. The dissemination of study findings, including videos produced by and starring transit employees, will provide information that can be used to tailor interventions aimed at increasing blue-collar worker participation in HMO-based smoking cessation activities. We expect the study results will address an important gap in research knowledge, and will have a significant impact across the state and the nation.