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Cost and benefit analysis of smoking cessation in the workplace

Contents:	Summary 1. Introduction 2. Review of the literature 3. Survey of Worksites in Scotland 4. Focus groups and interviews with occupational health and personnel staff 5. The cost of employee smoking in Scotland 6. Conclusions and recommendations 7. References Appendices

3. Survey of Worksites in Scotland

3.2 Methodology

A stratified random sample was drawn based upon the number of workers in Scotland employed in the different SIC categories. Employment in the 10 SIC sectors in Scotland is shown in Table 2.1.

A list of Scottish companies was compiled from local authority business directories, the Scottish section of the business directory Kompass and lists of local authorities and Health Boards. The study did not exclusively use Kompass as a source of company information as has been done in several previous surveys since this directory is limited to industrial suppliers and excludes firms in the consumer good industries and also most public sector organisations. Only companies with over 50 employees were included. Fifty was chosen because of the difficulties in compiling a stratified sample of firms with 100 or more employees.

Table 2.1: Employment in Scotland 1994

	SIC code	Group	Scotland Employment	%
	0	Agriculture, forestry and fishing	25,000	1.28
	1	Energy and water supply	50,000	2.57
	2	Metal manufacturing and chemicals	36,000	1.85
	3	Metal goods, engineering and vehicles	148,000	7.60
	4	Other manufacturing	166,000	8.52
	5	Construction	102,000	5.24
	6	Wholesale distribution, hotels and catering	406,000	20.84
	7	Transport and communication	109,000	5.60
	8	Banking, insurance and finance	202,000	10.37
	9	Education, health services and other	704,000	36.14
		Total	1,948,000	100

Source: Employment Gazette

The directories used to draw the sample did not all use the same industrial classifications, hence firms were allocated to the closest SIC code. Furthermore, many firms are involved in activities which overlapped several different SIC codes. The number of firms in each sector to be contacted for the telephone survey were drawn from the SIC categories according to the proportion of the Scottish workforce employed in that sector. However, due to the distribution of Scottish employment across the 10 SIC sectors, some of the sectors were too small to provide meaningful results when presented in SIC codes. In order to present the results disaggregated by broad industrial groups, the results were therefore presented by combining SIC codes. The groups used for this study are shown in Table 2.2. The ‘manufacturing’ group comprises of firms engaged in manufacturing activities, together with energy and water supply industries. The second group comprises a non-office based service sector. The third group includes office based services and public sector organisations. The aim of this aggregation was to group together industries producing similar outputs whilst preserving the basic SIC groupings by which employment statistics are published.

Table 2.2: Industrial groups used for the study

Manufacturing	Energy & water supply, manufacturing, engineering & vehicles
Non- office services	Construction, distribution, hotel & catering, transport & communication
Office and public sector	Banking, insurance, finance, education, health services & other services

Interviews were conducted over the telephone and were based on a questionnaire. A 30 item questionnaire was piloted with 6 employers before the survey was undertaken. However, after the pilot phase it was decided to use a shortened 18 item version (see Appendix 3) as the original questionnaire was time consuming, therefore making it unpopular with respondents. Appendix 3 also presents the full results from the survey.

The revised questionnaire collected basic information about the firm including number of employees and the industrial activities of the firm. Information was then collected about the type of smoking policy in operation at the firm. If smoking cessation help was offered the details of the programme were compiled. Finally the employer was asked about their perceptions of the costs and benefits of restricting smoking at the workplace and offering cessation help.

A total of 200 firms were contacted. If it was not possible to contact the appropriate person in the company after three attempts, the inquiry was pursued no further. There were three refusals to participate in the survey. In the remaining firms it was either not possible to make contact with the person responsible for the policy (22 firms) or the firm had ceased trading or it was not possible to contact the firm (eight firms). This procedure produced 167 completed questionnaires.

3.3 Results

The number of successful interviews completed in the three employment categories are shown in Table 2.3, together with the numbers of firms with a restrictive workplace smoking policy and the proportions of these policies which are written.

Table 2.3: Smoking policies in worksites in Scotland

	Interviews completed	Firms with a smoking policy		Written smoking policies
	n	n	%	n	%
Manufacturing	41	35	85%	32	91%
Non office services	49	44	90%	31	70%
Office & public sector	77	77	100%	70	91%
Full sample	167	156	93%	133	85%

Table 2.4 shows the types of smoking restrictions which were in place in the firms sampled. Of the 156 firms in the sample, 57% restricted smoking to a ‘smoke room’. This was the most common policy across all three industrial groups. A smoke free building policy was operated by 37% of employers. Three employers placed restrictions upon the times at which employees are allowed to smoke. Seven employers stated that the decision over whether to allow smoking in an office was based upon individuals’ preferences.

Table 2.4: Types of smoking policies in sample of Scottish firms

Policy

Group

Smoke free building

Smoking allowed in ‘smoke room’ only

Smoking allowed at certain times only

Other

Total

	n	%	n	%	n	%	n	%	n
Manufacturing	9	26%	25	71%	-	-	1	3%	35
Non office services	18	41%	21	48%	-	-	5	9%	44
Office & public sector	30	39%	43	56%	3	4%	1	1%	77
Full sample	57	37%	89	57%	3	2%	7	4%	156

A total of 41 firms of the 156 with a smoking policy (26.3%) indicated having experienced problems with the policy. The problems identified are shown in Table 2.5.

Table 2.5: Problems experienced with smoking policies

Problem

Responses *

Smoke breaks - productivity loss and non-smokers perceived unfairness	17
Complaints from smokers	16
‘Fly-smoking’ in toilets	6
Senior staff ignoring ban	3
Staff congregating at entrance; litter and negative image	4

* Figures do not add to 41 due to multiple responses

Forty-nine of the 167 firms surveyed offered cessation help to employees wishing to stop smoking. The proportions of firms offering cessation help to employees wishing to stop smoking by industrial group are shown in Table 2.6. Cessation help had been offered by 21 employers temporarily whilst a no-smoking policy was introduced but indicated that there had been a very disappointing uptake and the decision was taken not to provide help as an on-going policy.

Table 2.6: Firms offering cessation help as an on-going policy

Firms offering cessation help

	Group	%	n
	Manufacturing	34%	14
	Non office services	16%	8
	Office & public sector	35%	27
	Full sample	29%	49

Table 2.7 shows who undertakes the cessation help in those workplaces providing help to smokers. It can be seen from the table that over half of the firms in the survey undertook the work ‘in house’ by using their own occupational health staff.

Table 2.7: Who undertakes cessation help†

	Occupational Health Staff		Outside Consultants		Other *		Unknown**
	%	n	%	n	%	n	%	n
Full sample	57%	28	20%	10	8%	4	14%	7

Figures show who provides cessation help in firms who have indicated that they offer such help to employees. The individual results were too small to report by group.

Notes

†	figures may not add due to rounding
*	includes help for workers to buy their own help and employers providing leaflets
**	“unknown” includes firms who do not have an on-going programme but would provide help if approached by an employee. In this case the provider of the help would be decided upon when help is requested.

The questionnaire included detailed questions about the smoking cessation element of the policy that firms were offering. None of the firms surveyed had undertaken any evaluation of the programme and there was little interest in obtaining such information. Knowledge of the smoking status of employees was not widespread and only nine firms claimed to know the prevalence of smoking amongst their employees, these estimates ranging from 17% to 80%. Very little interest was also shown in sources of help concerning smoking cessation programmes except for the three companies which requested ‘Smokeline’ information and two which requested the address of the local Health Board.

Employers perceptions of the major benefits from introducing worksite smoking restrictions are shown in Table 2.8.

Table 2.8: Employers’ perceived benefits of worksite smoking restrictions

	Reductions in Absenteeism	Cost savings	Health benefits	Hygiene benefits	Legal issues	Morale benefits	Safety issues
Full sample	2	19	130	30	9	9	40

Note:

Figures show number of firms Figures do not add due to multiple responses

As regards the major costs of worksite smoking restrictions, reduced productivity was cited by 17 employers. This was a concern about smokers leaving their tasks to smoke in permitted areas, such as a smoke room or outside the building. Nine employers believed there was a cost involved when introducing a restrictive smoking policy because of the equipment needed. These costs included having to release productive work space in order to provide a smoke room, and also the equipment such as extractor fans needed for such a facility.

3.4 Discussion

The vast majority of Scottish employers now restrict smoking in the workplace: 93% of employers in the telephone survey had in place some form of restrictive smoking policy. The results from a stratified random sample of 200 employers across Scotland, indicated that 93% of the 167 employers completing the questionnaire operated some form of restriction on employee smoking. The most common policy was to confine smoking to designated areas of the building(s) only, (operated by 53% of the 167 survey respondents). Total smoking bans (no smoking is allowed anywhere in the building) was operated by over a third of firms taking part in the survey. Many of the employers believed restrictions on smoking to be the norm and that the freedom to smoke at work was the exception.

Problems associated with the worksite smoking policy were experienced by 26% of firms in the survey. The most common problems identified were productivity losses when smokers leave their tasks in order to smoke (cited by 17 employers) which had been noticed to create workplace tensions as non-smokers were aggrieved at the longer breaks enjoyed by smoking colleagues. Attempts to resolve the problem included one employer’s requirement that workers ‘clock out’ for smoke breaks, whilst another employer required that workers wishing to take a smoke break must work an extra half hour each day. Nine employers currently operating a complete worksite smoking ban stated that employees congregating at the entrance to the building and creating an undesirable corporate image and large amounts of litter was presenting a problem.

The results did show an awareness amongst employers of the health benefits of a restrictive smoking policy with 84% of employers in the survey citing ‘benefits to health’ as a major benefit of a restrictive smoking policy. The other key benefits identified by firms were safety, hygiene and cost-savings (including savings in damage to plant and machinery and reduced insurance costs). A significant reduction in computer failures and consequently repair costs had been noticed by one firm following the institution of a no-smoking policy. Three employers stated that a written policy was beneficial as it made clear the position of employers and employees as regards the policy towards smoking.

There does appear to be a lack of knowledge surrounding the wider cost-saving benefits of policies aimed to help employees stop smoking. Reducing absence from work was only identified as a benefit by two of the 167 employers interviewed despite the evidence from the studies outlined above (see Section 2.2.1).

Several external influences were noted to have brought about the introduction of no-smoking policies such as health and safety regulations for companies in the food and drink industry, trade union pressure and landlord’s regulations for firms occupying rented accommodation. Insurance companies also dictated a no-smoking policy in three warehouse based organisations. However, one firm indicated that insurance costs may actually be higher in premises with a total smoking ban and no ‘smoking room’ since it was feared that employees may smoke in areas of the building where they are unlikely to be detected, and where the absence of proper disposal facilities can lead to fire hazards.

Two carefully planned approaches to the introduction of a worksite smoking ban were noted to have been successful. A phasing-in of the policy whereby smoking is initially restricted to certain areas of the premises, then to smoke rooms which are then removed after a period of time was thought to have helped the employees in one organisation to accept the policy without the opposition which is often experienced. Two other employers reported setting up working groups including both smoking and non-smoking employees, trade unions and employers representatives, therefore allowing conflicting views to be raised. These approaches follow the recommendations for the introduction of a restrictive smoking policy put forward by Rosenstock et al. (1986) as outlined above in Section 2.4.2.

Amongst the firms with no policy, four stated that this was the case because senior staff from who the policy decision would be forthcoming were themselves smokers and were not prepared to initiate a restrictive policy. Three firms with policies also reported senior staff ignoring the ban.

3.5 Conclusions

The telephone survey showed that employers were willing to be interviewed but only with a limited questionnaire. Employers were generally interested in the issues of restrictive smoking policies as shown by there being only three refusals to participate. A difficulty involved in the survey was in constructing an adequate sampling frame, as there are a large number of small employers in Scotland. The list was compiled from a variety of sources, such as local authorities’ business directories, and lists of local authorities and health boards. This was time consuming but avoided the problems of bias which would result from using a directory such as Kompass.

The survey results showed that most firms across Scotland do have some kind of smoking restrictions, although there are several different types of policy in operation. The majority of employers were aware of the health benefits of introducing a restrictive smoking policy, although knowledge of other benefits was limited.

Twenty nine percent of the full sample offered cessation help to employees wanting to stop smoking, although employers appeared not to be aware of the wider benefits such as the potential reductions in absenteeism identified in the literature. The lack of knowledge surrounding the costs and benefits of such policies was a consistent finding throughout the survey. Cessation help had been offered by 21 of the employers whilst instituting the restrictive smoking policy, but this had been discontinued due to poor take up, a problem also noted in the focus group work in Section 4.

3.1 Introduction

This chapter outlines the methodology and results of a survey of workplaces in Scotland which was undertaken in January and February 1996 to collect information about smoking policies and help offered to employees wishing to stop smoking.

The survey of Scottish employers was undertaken in order to investigate the various smoking policies currently in place and the attitudes of employers to such policies. The survey population was a random sample of Scottish employers. A random sample was used in order to remove any potential biases which might be evident if the sample was drawn by a non-random method.

The survey asked whether the employer had a policy restricting smoking at the workplace, what the characteristics of that policy were, whether any problems had been experienced and whether the firm offered cessation help to its employees. The employer was then asked their views on the costs and benefits of worksite smoking policies.