Using the social cognitive theory to reduce smoking among night shift workers

1. Using the social cognitive theory to reduce smoking among night shift workers Presented by Allison Erickson MPH 515: Principles of Health Behavior

2. Basic information about smoking • Number one leading cause of preventable death in the United States, leading to more than 440,000 deaths per year (CDC, 2013) • “Smoking causes an estimated 90% of all lung cancer deaths in menand 80% of all lung cancer deaths in women.” (CDC, 2013) • The chemicals found in cigarettes are known to cause hypertension, leading to CVD (CDC, 2013) (see image)

3. Why night shift workers? • United States works 24 hours per day, 7 days per week, 365 days per year • Shift work (or irregular working hours) is working between 6:00pm-7:00am any day of the week • Around 21 million Americans work some form of shift work (McMenamin, 2007) • 40% increased risk for CVD compared to day workers (Wang et al., 2011) • Night shift workers consume tobacco products two times more often than day shift workers (Circadian Age, Inc., 2009) • Increase in tobacco use in this population exacerbates adverse health effects, like CVD

4. Overview of the literature • Using aspects of different ecological theories, researchers showed that blue-collar workers had a 55.2% prevalence of smoking compared to 33.1% of white-collar workers (Nishiura et al., 2009) • Work environments impact the prevalence of smoking (Nishiura et al., 2009) • “…education should be individually tailored and reinforced by taking the social environment into account”(Nishiura et al., 2009, p. 54)

5. The wellness program: Target Audience • Place • Suburb of a metropolitan city • Small manufacturing company (50-75 employees) • All employees work between 8:00pm and 6:00am • Over half use tobacco products, primarily smoking cigarettes • The problem: • Leadership has received complaints from non-tobacco using employees about the smoke coming in the building and frequent cigarette breaks • More people are taking unnecessary breaks costing the company time and money • Name of Program: “Quit for YOU!”

6. The wellness program: Social Cognitive Theory (SCT) • Focuses on one’s social environment, one’s personal characteristics, and behavioral interactions with others • Five constructs: • Knowledge • Perceived self-efficacy • Outcome expectations • Goal formation • Sociostructural factors Bandura’s Triadic Reciprocal Determinism

7. The wellness program: SCT Application • Knowledge: • Receive knowledge about how tobacco use is beneficial to the night shift workers • Motivational Interviewing (MI) to create a gateway of knowledge about changing behaviors and the benefit of the change • Posters, brochures, and quick facts about smoking dangers and information about the program will be posted around the worksite • Perceived Self-Efficacy • The wellness staff will evaluate the employee’s perceived ability to make the change based on past quit experiences including quit attempts and what has worked or not worked • Ask about task-specific understanding of making the change • The use of group sessions will aid in increased self-efficacy

8. The wellness program: SCT Application • Outcome Expectations • Benefits will be examined on the personal, familial, workplace, financial, and workplace levels • Positive message and self-talk: “If I quit smoking, then I will have whiter teeth” instead of “If I quit smoking, I will be tired all the time.” • Will also be evaluated at the beginning to gauge the expectations of the employees prior to starting the program • Goal Formation: • Individual and group goal setting processes • Use of SMART goals for the individual sessions • The groups will set goals that are more target oriented and group developed • As goals are met, the goal would be for self-efficacy to increase as well for the individual and the group together

9. The wellness program: SCT Application • Sociostructural Factors: • Long-term goal of the program is to begin to change the culture from a smoking culture workplace to a workplace of intolerance toward smoking • Develop unity and comradery among those quitting to boost motivation and self-efficacy • Wellness staff will utilize leadership from the company to cheer the employees on and engage with them in conversation about how this will impact the life of the employee personally, but also how the change will impact the culture of the workplace for good

10. Conclusion • In 1999, the CDC reported a total loss of $157 billion due to tobacco use in America (PACP, n.d.) • The need for tobacco cessation programs in workplaces will save money all around and save millions of lives • Utilizing health behavior theory for program development and implantation, health professionals will be able to effectively and scientifically assist positive health behavior change.

11. References • Centers for Disease Control and Prevention. (2013). Health effects of cigarette smoking. Retrieved from: http://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/index.htm • McMenamin, T.M. (2007). A time to work: Recent trends in shift work and flexible schedules. Retrieved from: http://www.bls.gov/opub/mlr/2007/12/art1full.pdf • Nishiura, C., Narai, R., Ohguri, T., Funahashi, A., Yarita, K., & Hashimoto, H. (2009). The effect of smoking prevalence at worksites on individual cessation behavior. Journal of Occupational Health, 51, 48-56. • Professional Assisted Cessation Therapy. (n.d.) Employers’ smoking cessation guide: Practical approaches to a costly workplace problem. Retrieved from: http://www.endsmoking.org/resources/employersguide/pdf/employersguide-2nd-edition.pdf • Wang, X.S., Armstrong, M.E.G., Cairns, B.J., Key, T.J., & Travis R.C. (2011). Shift work and chronic disease: The epidemiological evidence. Occupational Medicine, 61, 78-89.