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Context
& Consequences of Smoking in a Blue-Collar Cohort
(TRDRP
Grant)
Principal
Investigator: Carol B. Cunradi, M.P.H., Ph.D.
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,
TRD 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 TRD 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.
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