MassBuilt: effectiveness of an apprenticeship site-based smoking cessation intervention for unionized building trades workers

Cassandra A Okechukwu, Nancy Krieger, Glorian Sorensen, Yi Li, Elizabeth M Barbeau, Cassandra A Okechukwu, Nancy Krieger, Glorian Sorensen, Yi Li, Elizabeth M Barbeau

Abstract

Objective: Blue-collar workers are difficult to reach and less likely to successfully quit smoking. The objective of this study was to test a training site-based smoking cessation intervention.

Methods: This study is a randomized-controlled trial of a smoking cessation intervention that integrated occupational health concerns and was delivered in collaboration with unions to apprentices at 10 sites (n = 1,213). We evaluated smoking cessation at 1 and 6 months post-intervention.

Results: The baseline prevalence of smoking was 41%. We observed significantly higher quit rates in the intervention versus control group (26% vs. 16.8%; p = 0.014) 1 month after the intervention. However, the effects diminished over time so that the difference in quit rate was not significant at 6 month post-intervention (9% vs. 7.2%; p = 0.48). Intervention group members nevertheless reported a significant decrease in smoking intensity (OR = 3.13; 95% CI: 1.55-6.31) at 6 months post-intervention, compared to controls.

Conclusion: The study demonstrates the feasibility of delivering an intervention through union apprentice programs. Furthermore, the notably better 1-month quit rate results among intervention members and the greater decrease in smoking intensity among intervention members who continued to smoke underscore the need to develop strategies to help reduce relapse among blue-collar workers who quit smoking.

Figures

Fig. 1
Fig. 1
Unadjusted differences in quit rate over time among smokers with complete data from all study periods (n = 490)
Fig. 2
Fig. 2
Unadjusted cross-sectional differences in quit rate among all smokers in the MassBuilt cohort (baseline: n = 763, 30 days after intervention: n = 621, 6 months after intervention: n = 525)

References

    1. CDC (2008) Targeting tobacco use: the nation’s leading cause of death. National Center for Chronic Disease Prevention and Health Promotion.
    1. WHO. Why is tobacco a public health priority
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.2105/AJPH.94.2.269', 'is_inner': False, 'url': 'https://doi.org/10.2105/ajph.94.2.269'}, {'type': 'PMC', 'value': 'PMC1448243', 'is_inner': False, 'url': 'http://www.ncbi.nlm.nih.gov/pmc/articles/pmc1448243/'}, {'type': 'PubMed', 'value': '14759942', 'is_inner': True, 'url': 'http://pubmed.ncbi.nlm.nih.gov/14759942/'}]}
    2. Barbeau EM, Krieger N, Soobader MJ (2004) Working class matters: socioeconomic disadvantage, race/ethnicity, gender, and smoking in NHIS 2000. Am J Public Health 94(2):269–278. doi:10.2105/AJPH.94.2.269
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'PubMed', 'value': '17898692', 'is_inner': True, 'url': 'http://pubmed.ncbi.nlm.nih.gov/17898692/'}]}
    2. CDC (2007) State-specific prevalence of cigarette smoking among adults and quitting among persons aged 18–35 years—United States, 2006. MMWR Morb Mortal Wkly Rep 56(38):993–996
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'PubMed', 'value': '13408401', 'is_inner': True, 'url': 'http://pubmed.ncbi.nlm.nih.gov/13408401/'}]}
    2. Haenszel W, Shimkin M, Miller H (1956) Tobacco smoking patterns in the United States. Public Health Monogr 45:1–111
    1. Giovino G, Pederson L, Trosclair A (2000) The prevalence of selected cigarette smoking behaviors by occupational class in the United States. Center for Disease Control and Prevention, Washington DC. June Report No.: 2002-148
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1007/BF00442009', 'is_inner': False, 'url': 'https://doi.org/10.1007/bf00442009'}, {'type': 'PubMed', 'value': '2498962', 'is_inner': True, 'url': 'http://pubmed.ncbi.nlm.nih.gov/2498962/'}]}
    2. Hasenfratz M, Michel C, Nil R, Battig K (1989) Can smoking increase attention in rapid information processing during noise? Electrocortical, physiological and behavioral effects. Psychopharmacology (Berl) 98(1):75–80. doi:10.1007/BF00442009
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'PMC', 'value': 'PMC2359318', 'is_inner': False, 'url': 'http://www.ncbi.nlm.nih.gov/pmc/articles/pmc2359318/'}, {'type': 'PubMed', 'value': '8982527', 'is_inner': True, 'url': 'http://pubmed.ncbi.nlm.nih.gov/8982527/'}]}
    2. Leigh JP (1996) Occupations, cigarette smoking, and lung cancer in the epidemiological follow-up to the NHANES I and the California occupational mortality study. Bull N Y Acad Med 73(2):370–397
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'PubMed', 'value': '8027876', 'is_inner': True, 'url': 'http://pubmed.ncbi.nlm.nih.gov/8027876/'}]}
    2. Nelson DE, Emont SL, Brackbill RM, Cameron LL, Peddicord J, Fiore MC (1994) Cigarette smoking prevalence by occupation in the United States. A comparison between 1978 to 1980 and 1987 to 1990. J Occup Med 36(5):516–525
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1097/00043764-197611000-00011', 'is_inner': False, 'url': 'https://doi.org/10.1097/00043764-197611000-00011'}, {'type': 'PubMed', 'value': '993866', 'is_inner': True, 'url': 'http://pubmed.ncbi.nlm.nih.gov/993866/'}]}
    2. Sterling TD, Weinkam JJ (1976) Smoking characteristics by type of employment. J Occup Med 18(11):743–754. doi:10.1097/00043764-197611000-00011
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1016/0277-9536(90)90348-V', 'is_inner': False, 'url': 'https://doi.org/10.1016/0277-9536(90)90348-v'}, {'type': 'PubMed', 'value': '2315728', 'is_inner': True, 'url': 'http://pubmed.ncbi.nlm.nih.gov/2315728/'}]}
    2. Sterling TD, Weinkam J (1990) The confounding of occupation and smoking and its consequences. Soc Sci Med 30(4):457–467. doi:10.1016/0277-9536(90)90348-V
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1080/15459620600854292', 'is_inner': False, 'url': 'https://doi.org/10.1080/15459620600854292'}, {'type': 'PubMed', 'value': '16857642', 'is_inner': True, 'url': 'http://pubmed.ncbi.nlm.nih.gov/16857642/'}]}
    2. Meeker JD, Susi P, Pellegrino A (2006) Comparison of occupational exposures among painters using three alternative blasting abrasives. J Occup Environ Hyg 3(9):D80–D84. doi:10.1080/15459620600854292
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1002/ajim.20406', 'is_inner': False, 'url': 'https://doi.org/10.1002/ajim.20406'}, {'type': 'PubMed', 'value': '17099903', 'is_inner': True, 'url': 'http://pubmed.ncbi.nlm.nih.gov/17099903/'}]}
    2. Oliver LC, Miracle-McMahill H (2006) Airway disease in highway and tunnel construction workers exposed to silica. Am J Ind Med 49(12):983–996. doi:10.1002/ajim.20406
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1093/annhyg/meg025', 'is_inner': False, 'url': 'https://doi.org/10.1093/annhyg/meg025'}, {'type': 'PubMed', 'value': '12581996', 'is_inner': True, 'url': 'http://pubmed.ncbi.nlm.nih.gov/12581996/'}]}
    2. Rappaport SM, Goldberg M, Susi P, Herrick RF (2003) Excessive exposure to silica in the US construction industry. Ann Occup Hyg 47(2):111–122. doi:10.1093/annhyg/meg025
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'PubMed', 'value': '10163305', 'is_inner': True, 'url': 'http://pubmed.ncbi.nlm.nih.gov/10163305/'}]}
    2. Sorensen G, Stoddard A, Hammond SK, Hebert JR, Avrunin JS, Ockene JK (1996) Double jeopardy: workplace hazards and behavioral risks for craftspersons and laborers. Am J Health Promot 10(5):355–363
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1016/S0034-5687(01)00268-7', 'is_inner': False, 'url': 'https://doi.org/10.1016/s0034-5687(01)00268-7'}, {'type': 'PubMed', 'value': '11535266', 'is_inner': True, 'url': 'http://pubmed.ncbi.nlm.nih.gov/11535266/'}]}
    2. Sorensen G (2001) Worksite tobacco control programs: the role of occupational health. Respir Physiol 128(1):89–102. doi:10.1016/S0034-5687(01)00268-7
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.2105/AJPH.93.2.221', 'is_inner': False, 'url': 'https://doi.org/10.2105/ajph.93.2.221'}, {'type': 'PMC', 'value': 'PMC1447720', 'is_inner': False, 'url': 'http://www.ncbi.nlm.nih.gov/pmc/articles/pmc1447720/'}, {'type': 'PubMed', 'value': '12554573', 'is_inner': True, 'url': 'http://pubmed.ncbi.nlm.nih.gov/12554573/'}]}
    2. Murray LR (2003) Sick and tired of being sick and tired: scientific evidence, methods, and research implications for racial and ethnic disparities in occupational health. Am J Public Health 93(2):221–226. doi:10.2105/AJPH.93.2.221
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'PubMed', 'value': '10186933', 'is_inner': True, 'url': 'http://pubmed.ncbi.nlm.nih.gov/10186933/'}]}
    2. Grosch JW, Alterman T, Petersen MR, Murphy LR (1998) Worksite health promotion programs in the U.S.: factors associated with availability and participation. Am J Health Promot 13(1):36–45
    1. Moher M, Hey K, Lancaster T (2005) Workplace interventions for smoking cessation. Cochrane Database Syst Rev (2):CD003440
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1006/pmed.2001.0988', 'is_inner': False, 'url': 'https://doi.org/10.1006/pmed.2001.0988'}, {'type': 'PubMed', 'value': '11902848', 'is_inner': True, 'url': 'http://pubmed.ncbi.nlm.nih.gov/11902848/'}]}
    2. Campbell MK, Tessaro I, DeVellis B, Benedict S, Kelsey K, Belton L et al (2002) Effects of a tailored health promotion program for female blue-collar workers: health works for women. Prev Med 34(3):313–323. doi:10.1006/pmed.2001.0988
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1177/109019819802500402', 'is_inner': False, 'url': 'https://doi.org/10.1177/109019819802500402'}, {'type': 'PubMed', 'value': '9690101', 'is_inner': True, 'url': 'http://pubmed.ncbi.nlm.nih.gov/9690101/'}]}
    2. Willemsen MC, de Vries H, van Breukelen G, Genders R (1998) Long-term effectiveness of two Dutch work site smoking cessation programs. Health Educ Behav 25(4):418–435. doi:10.1177/109019819802500402
    1. US-DHHS (2006) In: Services DoHaH (ed) Control of secondhand smoke exposure. Office on Smoking and Health, pp 569–665
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.2307/3590981', 'is_inner': False, 'url': 'https://doi.org/10.2307/3590981'}]}
    2. Bilginsoy C (2003) The hazards of training: attrition and retention in construction industry apprenticeship programs. Ind Labor Relat Rev 57(1):54–66. doi:10.2307/3590981
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.2105/AJPH.94.2.230', 'is_inner': False, 'url': 'https://doi.org/10.2105/ajph.94.2.230'}, {'type': 'PMC', 'value': 'PMC1448233', 'is_inner': False, 'url': 'http://www.ncbi.nlm.nih.gov/pmc/articles/pmc1448233/'}, {'type': 'PubMed', 'value': '14759932', 'is_inner': True, 'url': 'http://pubmed.ncbi.nlm.nih.gov/14759932/'}]}
    2. Sorensen G, Barbeau E, Hunt M, Emmons K (2004) Reducing social disparities in tobacco use: a social contextual model for reducing tobacco use among blue collar workers. Am J Public Health 94(2):230–239. doi:10.2105/AJPH.94.2.230
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1023/A:1016385001695', 'is_inner': False, 'url': 'https://doi.org/10.1023/a:1016385001695'}, {'type': 'PubMed', 'value': '12195637', 'is_inner': True, 'url': 'http://pubmed.ncbi.nlm.nih.gov/12195637/'}]}
    2. Sorensen G, Stoddard AM, LaMontagne AD, Emmons K, Hunt MK, Youngstrom R et al (2002) A comprehensive worksite cancer prevention intervention: behavior change results from a randomized controlled trial (United States). Cancer Causes Control 13(6):493–502. doi:10.1023/A:1016385001695
    1. None
    2. Fiore M, Bailey W, Cohen S (2000) Treating tobacco use and dependence. Clinical practice guideline. DHHS, Rockville
    1. BUILT [database on the Internet] (2006) State building & construction trades council of California. . Cited 31 Oct 2007
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1007/s10552-005-0271-0', 'is_inner': False, 'url': 'https://doi.org/10.1007/s10552-005-0271-0'}, {'type': 'PubMed', 'value': '16411053', 'is_inner': True, 'url': 'http://pubmed.ncbi.nlm.nih.gov/16411053/'}]}
    2. Barbeau EM, Li Y, Calderon P, Hartman C, Quinn M, Markkanen P et al (2006) Results of a union-based smoking cessation intervention for apprentice iron workers (United States). Cancer Causes Control 17(1):53–61. doi:10.1007/s10552-005-0271-0
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'PubMed', 'value': '12745503', 'is_inner': True, 'url': 'http://pubmed.ncbi.nlm.nih.gov/12745503/'}]}
    2. Hughes JR, Keely JP, Niaura RS, Ossip-Klein DJ, Richmond RL, Swan GE (2003) Measures of abstinence in clinical trials: issues and recommendations. Nicotine Tob Res 5(1):13–25
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1037/0022-3514.48.5.1279', 'is_inner': False, 'url': 'https://doi.org/10.1037/0022-3514.48.5.1279'}, {'type': 'PubMed', 'value': '3998990', 'is_inner': True, 'url': 'http://pubmed.ncbi.nlm.nih.gov/3998990/'}]}
    2. Velicer WF, DiClemente CC, Prochaska JO, Brandenburg N (1985) Decisional balance measure for assessing and predicting smoking status. J Pers Soc Psychol 48(5):1279–1289. doi:10.1037/0022-3514.48.5.1279
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1016/0306-4603(90)90070-E', 'is_inner': False, 'url': 'https://doi.org/10.1016/0306-4603(90)90070-e'}, {'type': 'PubMed', 'value': '2378287', 'is_inner': True, 'url': 'http://pubmed.ncbi.nlm.nih.gov/2378287/'}]}
    2. Velicer WF, Diclemente CC, Rossi JS, Prochaska JO (1990) Relapse situations and self-efficacy: an integrative model. Addict Behav 15(3):271–283. doi:10.1016/0306-4603(90)90070-E
    1. SAS (2005) The GLIMMIX procedure. SAS, Cary, NC. . November
    1. None
    2. King G, Honaker J, Joseph A, Scheve K (2001) Analyzing incomplete political science data: an alternative algorithm for multiple imputation. Am Polit Sci Rev 95(1):49–69
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1097/JOM.0b013e31802ec68c', 'is_inner': False, 'url': 'https://doi.org/10.1097/jom.0b013e31802ec68c'}, {'type': 'PubMed', 'value': '17215716', 'is_inner': True, 'url': 'http://pubmed.ncbi.nlm.nih.gov/17215716/'}]}
    2. Lee DJ, Fleming LE, Arheart KL, LeBlanc WG, Caban AJ, Chung-Bridges K et al (2007) Smoking rate trends in U.S. occupational groups: the 1987 to 2004 national health interview survey. J Occup Environ Med 49(1):75–81. doi:10.1097/JOM.0b013e31802ec68c
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1111/j.1360-0443.2004.00540.x', 'is_inner': False, 'url': 'https://doi.org/10.1111/j.1360-0443.2004.00540.x'}, {'type': 'PubMed', 'value': '14678060', 'is_inner': True, 'url': 'http://pubmed.ncbi.nlm.nih.gov/14678060/'}]}
    2. Hughes JR, Keely J, Naud S (2004) Shape of the relapse curve and long-term abstinence among untreated smokers. Addiction 99(1):29–38. doi:10.1111/j.1360-0443.2004.00540.x
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'PubMed', 'value': '17065979', 'is_inner': True, 'url': 'http://pubmed.ncbi.nlm.nih.gov/17065979/'}]}
    2. CDC (2006) Tobacco use among adults—United States, 2005. MMWR Morb Mortal Wkly Rep 55(42):1145–1148
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1006/pmed.1995.1065', 'is_inner': False, 'url': 'https://doi.org/10.1006/pmed.1995.1065'}, {'type': 'PubMed', 'value': '7479632', 'is_inner': True, 'url': 'http://pubmed.ncbi.nlm.nih.gov/7479632/'}]}
    2. Velicer WF, Fava JL, Prochaska JO, Abrams DB, Emmons KM, Pierce JP (1995) Distribution of smokers by stage in three representative samples. Prev Med 24(4):401–411. doi:10.1006/pmed.1995.1065
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'PubMed', 'value': '15768924', 'is_inner': True, 'url': 'http://pubmed.ncbi.nlm.nih.gov/15768924/'}]}
    2. Barbeau EM, Goldman R, Roelofs C, Gagne J, Harden E, Conlan K et al (2005) A new channel for health promotion: building trade unions. Am J Health Promot 19(4):297–303
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1002/ajim.10129', 'is_inner': False, 'url': 'https://doi.org/10.1002/ajim.10129'}, {'type': 'PubMed', 'value': '12382249', 'is_inner': True, 'url': 'http://pubmed.ncbi.nlm.nih.gov/12382249/'}]}
    2. Ringen K, Anderson N, McAfee T, Zbikowski SM, Fales D (2002) Smoking cessation in a blue-collar population: results from an evidence-based pilot program. Am J Ind Med 42(5):367–377. doi:10.1002/ajim.10129

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