Researcher aims to combat high smoking rates among construction workers
Key takeaways:
- Smoking rates are 30% among construction workers vs. 15% among the general population.
- The goal of the grant is to test the implementation of smoking cessation interventions.
The Florida Department of Health awarded a more than $1.4 million grant to Taghrid Asfar, MD, MSPH, to develop new smoking cessation treatments for construction workers.
Asfar, associate professor in the division of epidemiology and population health sciences in the department of public health sciences at Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, has been involved in smoking cessation efforts for nearly 2 decades.
The goal of the current grant is to support her continued efforts in improving smoking cessation outcomes among high-risk populations.
“We are still in the very beginning stages but anticipate getting started on this new initiative in May. We have already begun communicating with construction companies, and enrollment has begun,” she told Healio. “We also have a team in place — the beauty of this project is the multidisciplinary team. We have smoking cessation experts, public health economic analysis experts, and implementation scientists. We look forward to a fruitful 5 years and hope our work will inform other populations across the country.”
Asfar spoke with Healio about why this specific population is the focus of her current work, how her career has prepared her to lead this initiative and her ultimate hope for her efforts.
Healio: What prompted the idea for this initiative?
Asfar: The Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine has conducted research in this area since 2014, using a nationally representative sample analysis where we compared smoking behavior by occupation. Results of that work showed that smoking rates are the highest among construction workers — the smoking rate is 15% among the general population compared with almost 30% among construction workers.
Driven by these results, we have conducted several other small studies that explored why this population appears to suffer most from this behavior. We found that they are a unique population. For example, especially here in South Florida, most construction workers are Hispanic immigrants and have very low access to health promotion in general and very little access to smoking cessation treatment programs.
Additionally, their work is very stressful and hectic. They move a lot from one construction site to another and from one project to another. In the past, they have not benefitted from the events we held to improve smoking cessation at the worksite. This population differs from the white collar or service workers, who have access to smoking cessation services on the worksite, and that makes it easy for them to receive cessation treatments because they don’t have to travel and it’s covered by their work. Whereas construction workers have the lowest coverage by such programs among all occupations (14% vs. 29%). This low coverage, coupled with construction workers’ high smoking rates, highlight a missed opportunity to reduce tobacco use and contain costs in the construction sector.
Another challenge with this population is that we need tailored programs for their special work circumstances and/or culture. They are a very different population, as most are Hispanic, especially in South Florida.
Results from another study that we conducted showed that almost 80% of construction workers here in South Florida are Hispanic. Among those workers, the smoking rate was between 60% and 70%. Following these data, we received a small, 2-year NCI grant where we developed a culturally sensitive smoking cessation program for Hispanic construction workers, and we tested it in a pilot study, which allowed us to build that relationship with the construction sector. The data from that pilot study informed the basis for this new large grant.
Healio: What are your plans for this new grant?
Asfar: Results of the pilot study showed that the safety manager on construction sites is the closest person to the construction workers. They lead daily morning meetings, discussing their plan for the day and providing advice about safety on the work site. The safety manager is basically the gatekeeper for construction workers and became our access point.
Building on that work, we want to use this grant to train safety managers to provide smoking cessation treatments to construction workers. We plan to test different treatment intensities because we know that the hectic work environment will make it difficult to have the luxury of intensive treatments. Therefore, we are testing low-intensity treatments and will increase the dose gradually among those who do not respond to low-dose treatment. We are calculating the cost for each intensity and studying the effectiveness of each intensity. The beauty of this study is that it is very innovative because we are testing not only one treatment, but we are testing several treatments at the same time, and we are also studying their cost and implementation feasibility in the construction sector. It is a free program, and we are also offering incentives for the participating safety manager and construction workers. Our ultimate goal is to implement free smoking cessation services in the construction sector.
Healio: Why is this issue so important to address?
Asfar: Our project will inform decision-makers in the construction sector about the cost and effectiveness of several options for smoking cessation treatment so that they can choose the best option to influence smoking cessation among construction workers.
We hope this project will successfully provide easy, accessible, effective and local smoking secession treatments for construction workers, regardless of their immigration status. The treatments will be offered in English and Spanish based on construction workers’ preferences, and all study materials will be available in the two languages.
Healio: How has your career so far prepared you for this work?
Asfar: I am originally from Syria, and in 2004, I started conducting research in tobacco control as part of an NIH-funded grant in Syria to develop a smoking cessation intervention. We found that smoking rates were super high — 57% of the population were current smokers. Unfortunately, we did not have any cessation treatments for smokers in Syria at that time. This is where I developed an interest in this area and wanted to help everyone to quit smoking.
I then moved to the U.S. in 2006 and worked at St. Jude Children’s Research Hospital, where I became involved in a National Quitline smoking cessation trial for childhood cancer survivors. I later adapted this research in Miami, where I always look for high-risk populations that are hard to reach and treat. I now have several ongoing pilot trials testing several smoking cessation strategies that include cancer survivors and patients with HIV. My research has adapted to target stress and anxiety because they are very well linked to smoking relapse after cessation. I am using technologies, such as smartphone applications for cancer survivors, to improve access to cessation treatments, and the outcomes of this work have been phenomenal. We have improved and reduced smoking rates in some of our populations, but certain populations still have higher smoking rates than the general population. Those populations need to be the focus of all future smoking cessation efforts here in the U.S.
Healio: Do you have anything else that you would like to mention?
Asfar: I would like to thank the Florida Department of Public Health for acknowledging this important research area, which is unique to South Florida, where we have the highest population of Hispanic construction workers in the nation. I would also like to thank the construction companies who have trusted us and allowed us access to their construction sites and workers to provide treatment and train their safety managers.
My wish is that in the future, this work will be translated to other states in the U.S. to build on this project and create a national network for improving smoking cessation and other health promotion activities among this population.
For more information:
Taghrid Asfar, MD, MSPH, can be reached at tasfar@med.miami.edu.
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