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Context & consequenes of smoking in a blue-collar cohort

Institution: Pacific Institute for Research and Evaluation
Investigator(s): Carol Cunradi, Ph.D., M.P.H.
Award Cycle: 2005 (Cycle 14) Grant #: 14RT-0116 Award: $426,555
Subject Area: Epidemiology
Award Type: Research Project Awards

Initial Award Abstract
Workers in blue-collar and service occupations smoke at higher rates than workers in white-collar and professional occupations. Past research suggests that job strain and occupational stress are associated with increased intensity of smoking and decreased quitting. Few studies, however, have examined smoking maintenance and cessation in relation to the occupational context (i.e., psychosocial job factors, such as frequency and significance of stressful job problems, job-related gender and ethnic discrimination, and length of time needed to unwind after work; physical workload; and ergonomic problems) of workers in known high-stress blue-collar occupations, such as urban transit operators. Past research also suggests that smokers have higher rates of adverse job outcomes (e.g., absenteeism, accidents, injuries) than non-smokers. Major limitations of this research are that the role of alcohol is often not accounted for, nor do these analyses adjust for physical workload and ergonomic problems. The overall goal of this study is to understand the occupational context of why and how smoking behavior occurs among a multiethnic cohort of male and female Northern California urban transit operators, and how this behavior is related to adverse occupational and health outcomes.

The proposed study will conduct a secondary analysis of data collected from 2,796 transit operators at the San Francisco Municipal Railway (MUNI) who participated in two cross-sectional occupational health and safety surveys in 1983-85 and 1993-95 that were administered in conjunction with a mandatory biennial medical exam. The relationship between occupational context and smoking behavior will be examined cross-sectionally among each cohort. Changes in smoking maintenance and cessation over 10 years among 1,016 workers who participated in both surveys will be analyzed longitudinally using data on the psychosocial and physical job environments. Historical prospective follow up through the year 2000 on smoking-related occupational outcomes, tobacco-related disease mortality, and all-cause mortality will be conducted for all operators using archival data sources (e.g., National Death Index mortality records, worker’s compensation claims, California Dept. of Motor Vehicles traffic violations and accident records) that will be linked with survey data. The majority of operators are African American, with the remainder divided among Hispanic, Asian and Pacific Islander, Filipino, and White. Approximately 15% of the cohort is female (n=419), allowing for meaningful subgroup analysis.

The specific aims of the study are to (1) determine the social-contextual occupational factors that underlie smoking maintenance and cessation among an understudied, multiethnic working class population; and (2) quantify the adverse occupational and health consequences of smoking, both independently and in conjunction with alcohol, and taking into account physical workload and ergonomic problems, among an understudied, multiethnic working class population. Following the Karasek et al. (1990) model of job strain and its impact on health behaviors, we hypothesize that psychosocial work factors, physical workload, and ergonomic problems will be positively associated with smoking maintenance, and negatively associated with smoking cessation; smoking will be associated with higher rates of adverse occupational outcomes, both independently and in conjunction with alcohol; and smoking will be associated with higher rates of tobacco-related disease mortality and all-cause mortality, both independently and in conjunction with alcohol. Since the proposal’s focus is on understanding the context and consequences of smoking behaviors among urban transit operators (a low SES, understudied population), and contains a majority of African Americans and other ethnic minorities, as well as a sizeable number of females, it directly addresses the goals of the Primary Area topic Prevention and Cessation of Tobacco Use and Tobacco-Related Health Disparities in California’s Diverse Populations. Study findings can provide the basis for future smoking prevention and cessation interventions that are occupationally and culturally tailored to employees at blue-collar work settings within California. Ultimately, the goal of this research is aimed at reducing tobacco-related health disparities among a traditionally underserved population of racial/ethnic minorities, women, and workers in blue-collar occupations.