Publication
Workplace Smoking Policies in Scotland
7. Cessation support
- The quantitative study examined whether workplaces offered any type of cessation support for their employees and their reasons for doing so (or not doing so). The qualitative study explored these reasons further in the case studies.
- Cessation support was only offered by one in ten workplaces (12%) in the quantitative survey, although this rose to two thirds of workplaces with 250+ employees (64%). The lack of support offered was explained by a lack of employee demand, the view that this was not an employer’s responsibility and, for some, a lack of resources.
- There was little awareness of what might help workplaces offer more support. If cessation services are to be used to facilitate workplace smoking policies, then awareness of specialist cessation support will have to be raised amongst both employers and employees.
- It was clear from the qualitative study that staff were not always aware of the cessation support offered by their companies. However, the most important theme to emerge from the qualitative work with regard to cessation was the view that helping smokers to quit was the government’s responsibility, not the employers’.
7.1 Quantitative Study
7.1.1 Support offeredJust over one in ten (12%) workplaces offered some kind of support to employees who wished to give up smoking, although the qualitative study showed that staff in such companies were not always aware of this.
Table 7.1: Percentage of workplaces that offer cessation support by size of workplace (%)
Size of Workplace |
% offering cessation support |
All workplaces (1604) |
12% |
All SME workplaces (1066) |
9% |
All workplaces in large organisations (538) |
27% |
SME workplaces with 2 to 49 employees (905) |
9% |
SME workplaces with 50-249 employees (160) |
19% |
Workplaces in large organisations with 2-249 employees (469) |
25% |
Workplaces in large organisations with 250+ employees (67) |
64% |
Base: All respondents |
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As was the case with many aspects of policy provision, the size of the organisation and the size of the workplace made a difference (Table 7.1). Workplaces from large organisations were more likely (27%) to offer cessation support than those from SMEs (9%). There was also a relationship between size of workplace and cessation support. This relationship was particularly striking for workplaces in large organisations, with those with over 250 employees much more likely to offer support (64%).
The number of employees is likely to impact on the support available in a number of ways. Whilst there were similar proportions of employees who smoked amongst the smallest and largest workplaces, this would equate, at the larger workplaces, to a far larger number of smokers, and thus more potential demand. In addition, resource availability, both financial and personnel, is likely to be more restricted in smaller workplaces, particularly those in SME organisations. The qualitative research indicated that smaller organisations often did not feel that they had sufficient staff or other resources to offer such support. In addition, they felt that neither their staff nor the wider society really expected them to do so. This will be discussed in more detail in Section 7.2, when considering the reasons given for not offering support.
Amongst the sectors, those from the social and personal services sector were most likely (27%) to offer some support whilst those from the construction sector were least likely (4%).
Table 7.2: Type of cessation support offered by workplaces offering any support (%)
Support offered |
All workplaces (270) |
SME workplaces (113) |
Workplaces in large organisations (157) |
Referral to support services |
49% |
38% |
73% |
Time off work for counselling |
36% |
34% |
41% |
In house counselling |
33% |
27% |
46% |
Provision of nicotine gum/patches |
19% |
19% |
19% |
Verbal encouragement |
19% |
26% |
2% |
Leaflets/written advice |
6% |
6% |
4% |
Base: All workplaces offering support to employees wishing to give up smoking |
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The most commonly offered form of support was referral to specialist support services, an approach taken by almost half (49%) of those offering support (Table 7.2). Referral to specialist support services is the recommended approach for employers in the current smoking cessation guidelines. Other support offered included giving employees time off work for counselling (36%), providing in-house counselling (33%), providing nicotine gum or patches (19%) and offering verbal encouragement (19%).
Workplaces in large organisations were more likely to offer referral to support services or in-house counselling, with SMEs more likely to offer verbal encouragement. Of the large organisations offering any support, only half (54%) of branches with a head office in Scotland referred their employees to specialist services compared with eight in ten (82%) branches with head offices elsewhere.
7.1.2 RationaleA variety of reasons were given by those not offering any support (Table 7.3) and the most common were having no or few employees who smoke (30%), not believing it was the organisation's responsibility (22%) and not having been asked to help (11%). Other reasons given included time, staff and financial resource issues (4%) and not knowing what they could do (1%).
Table 7.3: Why not offering support for employees wishing to give up smoking (%)
|
All workplaces (1604) |
SME workplaces (1066) |
Workplaces in large organisations (538) |
No/only a few employees smoke |
30% |
33% |
3% |
Not organisations responsibility |
22% |
22% |
14% |
Never been asked for help |
11% |
11% |
8% |
Don't know |
22% |
18% |
64% |
Base: All respondents |
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Workplaces from SMEs were more likely to give a reason in response to this question, whereas those from larger organisations were most likely to say they did not know why they did not offer support (64%). This is probably linked to the high proportion of workplaces in large organisations whose policy is decided at head office. SME workplaces were considerably more likely to say that they had too few employees who smoke (33%) than workplaces in larger organisations (3%).
All respondents were asked what would help them provide cessation support (if they were not currently doing so) and what would help them provide more cessation support (if they were already offering some support). There was little consensus amongst respondents about what help they needed, with six in ten (63%) stating that they did not know what would help. The most frequently given answers are included in Table 7.4, and followed general themes of information, funding and support from existing services. There was no clear difference between workplaces in SME and large organisations.
Table 7.4: What would help workplaces offer (more) support for employees who wish to give up smoking (%)
Type of support needed |
All workplaces (1604) |
SME workplaces (1066) |
Workplaces in large organisations (538) |
Information leaflets/posters/helplines |
6% |
6% |
10% |
Support of cessation services |
6% |
6% |
8% |
Government funding |
4% |
4% |
3% |
More information/advice on where to get help/support |
3% |
3% |
4% |
Don't know |
63% |
63% |
65% |
Have no employees who smoke |
3% |
4% |
* |
Base: All respondents |
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One in ten branches of large organisations (10%) with a head office in Scotland would like support from the cessation services and/or more information about where to get support. This, coupled with the finding that these branches were least likely to be referring employees to cessation services, suggests that employers need to be better advised about the availability of services within Scotland. Furthermore, the high proportion of “don't know” responses seems to indicate a general lack of information about the type of help that is available. If cessation support is to facilitate the implementation of workplace smoking policies, workplaces will certainly need to be better informed of the services available.
7.2 Qualitative Study
It was noticeable that the HR contacts or owners/managers (who had answered the survey) were sometimes more aware of the help that could be offered, or was already available, than other members of staff. Staff occasionally reported seeing information about NHS helplines but they were often not aware of any leaflets or other support. It also seemed that theoretical agreement from a boss that providing support could be positive for the business and was a possibility for their company was not necessarily translated into action. In one business, the manager stated that he believed it would be useful for somebody to come to the business to give support and advice to his staff. However, the staff reported that a smoking cessation advisor had suggested coming in to give classes in the workplace (because staff had difficulty fitting the classes in with their shifts), but the manager had refused to allow time for it in work hours.
Several owners, managers and staff suggested that they would welcome advice or support from NHS advisors for the business or for individual employees. One commented that he was aware of advice available from the Health and Safety Executive but that they charged for it, and he had therefore not taken it up.
Underlying the discussion of cessation support was a general belief that it was the government rather than employers who should bear the main responsibility for offering support. Respondents were particularly insistent that the government should provide helplines, classes and counselling, if a ban on smoking in public places or at work were to be introduced.
As was the case in the survey, sector did appear to influence attitudes to cessation support. The case study organisation involved in providing social services felt that employers could do more to help and support staff. They reported providing referrals to specialist services and occupational health counselling for staff. This seemed to arise from a wider awareness that their staff were under a great deal of pressure and from a culture which was strongly focused on the need to support people and ensure that they received help where it was needed. The support provided to help staff stop smoking was part of a wider provision of referrals to support services and assistance at work to cope with a range of problems.
In addition to the view that employers did not bear the main responsibility for providing cessation support, there was also a strong belief that large employers were far more able to give help and support than small ones. Small businesses did not feel that they had the margin of time, resources or staff to become involved in this level of care. They also did not believe that it was expected of them by staff or by the wider community.
"I suppose bigger companies...that can afford to do that, yes they should do it...To be honest...to have this blanket no smoking policy, I don't know if it's really [for the] workplace or not." (Non-smoker, 2-4 employees, retail).
Where companies were seriously considering providing more cessation support, the driver behind it was HR policies emerging from head offices rather than a branch level decision to address the issue. Even in this case, however, the branch HR manager was sceptical as to whether the company would actually be prepared to invest in such support.
Overall, employers were seen to have a duty of care to enable non-smokers not to breathe others' smoke, although there were wide variations in how this duty was interpreted. However, companies were not believed to have a duty to attempt to persuade smokers to quit. In fact, smokers and non-smokers felt strongly that the decision to smoke was a matter of personal choice and that employers should not attempt to push employees into a particular decision.
"I don't particularly want companies to be like big overlords, and I don't think they should have the right to say no smoking at their workplaces." (Non-smoker, 10-49 employees, retail).
Some staff and managers made suggestions about ways in which employers could provide assistance. These included sending a representative to an NHS class so that they could report back ideas about how to quit, putting up posters giving information about sources of help, having leaflets to educate people about the risks of smoking and having an internal support group (in a big company). However, these were suggested as ideas which might be nice. They were not really seen as the employers' responsibility and there was little enthusiasm for implementing them. Some managers acknowledged the arguments about the benefits to the company of smokers' quitting. However, they did not feel that these benefits would be certain enough or large enough to justify investment in cessation support.