New avenues for smoking prevention in small businesses

A qualitative study indicates that comprehensive anti-smoking policies within companies, fairer management of breaks, the "non-stigmatization" of smokers and consultation with employees on planned actions are levers to be prioritized in small businesses.

Depending on the country and the calculation method, 90 to 95% of companies are small (fewer than 250 employees). However, it is mainly in large companies that the majority of smoking prevention actions are deployed. Companies with more than 500 employees have larger prevention budgets and, for example, in the United States, concentrate 74% of smoking cessation interventions, compared to 16 to 35% for companies with 10 to 249 employees. In fact, scientific studies on the subject mainly reflect what happens in large companies. In order to identify the obstacles and levers of smoking prevention in small companies, a qualitative study in the United States explored the expectations of employers as well as those of employees.[1].

An expectation of equal treatment between employees

Twelve interviews were conducted with employers and four focus groups were conducted with smoking and non-smoking employees in a variety of sectors. Employers appear to have the impression that the proportion of smokers among their workforce is very low, which discourages them from considering tobacco prevention initiatives as a priority. This perception may be biased, since the smoking employees surveyed frequently report hiding their tobacco consumption from their colleagues and employers for fear of being "stigmatized," a fact of which some employers are aware. This situation, specific to the United States, leads smoking employees to adopt various concealment strategies, whether by taking time off work to smoke, using alternative products (e-cigarettes, oral products), or using perfumes to camouflage the smell of tobacco. Not wanting to be questioned about their consumption, smoking employees advocate anti-smoking actions integrated into other health promotion themes.

Whether smokers or non-smokers, employees appeared more open than employers to preventing smoking in the workplace, but tended to consider that the employer was more concerned about their productivity than their health. In the interest of fairness, employees would also prefer that breaks not be granted only to smokers, who take more and in a less controlled manner. This finding is consistent with that of other studies in the workplace, which have already highlighted unregulated breaks for smokers as a source of both lower productivity and tension within work teams.[2].

Still in the interest of fairness, employees believe that the widespread ban on smoking at work should be supplemented by a ban on vaping, which is not yet systematic in the United States. Vaping was generally perceived by employees as a cause of pollution in the workplace, leading to higher nicotine consumption and being poorly suited to smoking cessation. However, electronic cigarettes would have the advantages of being more discreet, better socially accepted than smoked tobacco, and significantly less odorous. Overall, employees, and even more so employers, believe that it is simpler and more obvious to adopt a protective measure in the workplace if it is already in effect in the state or the rest of society.

A preference for actions demonstrated to be effective

Regarding the types of desired prevention actions, employees primarily recommend financial or material incentives (gift vouchers) and workplace coaching sessions. More marginally, they suggest completely smoke-free company policies that include vaping, and advocate support from colleagues and a mobile phone tracking application. Email and the intranet are the communication methods they consider most appropriate for announcing prevention actions. These proposals are consistent with prevention interventions based on scientific evidence, which recommend the use of personalized text messages for smoking cessation, material or financial incentives, and coverage for substitution treatments or supplementary health insurance.

Employers, for their part, showed a greater interest in "turnkey" prevention actions, and more generally in proven actions, adapted to their structure and equipped with incentive graphic material (posters, for example). Some of these employers said they were ready to implement prevention actions if sufficient demand was expressed – which seems difficult given the muted stigmatization to which smoking employees are said to be subject. While employers' perception of these actions mainly reflected their company's culture on health issues, the smoking status of managers and its evolution can also influence this perception.

As the study was conducted in the midst of a pandemic, the impact of COVID-19 on employee smoking was spontaneously raised. Employees' impression was that tobacco consumption had increased during this period, and had been particularly encouraged by both teleworking and stress. Teleworking was also perceived as encouraging vaping during working hours, or even switching to a form of smokeless tobacco (mentioned once, in order not to disturb roommates). Only a minority of the employers surveyed acknowledged that the pandemic had reduced interest in smoking prevention, with the others believing it had had no particular influence.

Two main limitations of this study were identified. The first was the general attitude towards smoking prevention, with respondents potentially being more supportive than those who declined to participate in the study. The second was the social background of the employees studied. Those surveyed in the study had relatively high salary levels, while employees in small businesses statistically have lower salaries. It therefore remains to be seen whether employees with the lowest salaries, who are also the most frequent smokers, show the same level of acceptance of smoking prevention initiatives. Their high presence in small businesses nevertheless suggests that these workplaces are fertile ground for reducing social disparities in health.

The results of this study also remain very linked to the American context, particularly with regard to material and financial incentives or the low social acceptance of smoking.

Keywords: small businesses, prevention, smoking, employers, employees

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[1] Kava C, Ruiz R, Harris J, Hannon P, Worksite tobacco control – a qualitative

study on perspectives from employers and employees at small worksites, BMC Public Health (2022) 22:904, https://doi.org/10.1186/s12889-022-13346-y.

[2] Petersen AB, Sarna L, Rezk-Hanna M, Wells M, Nohavova I, Bialous S. “Everyone needs a breath of fresh air”: Workplace impact on nurses’ smoking behaviors. Cancer Nurs. 2020;43(4):319–30.