Workplace Smoking Research Articles

Determinants of intentions to quit smoking among adult smokers in Bangladesh: findings from the International Tobacco Control (ITC) Bangladesh wave 2 survey.

BackgroundWith about 22 million adult smokers, Bangladesh needs strong measures that would promote smoking cessation. Using data from Wave 2 of the International Tobacco Control (ITC) Survey, this study examined the factors associated with intention to quit smoking among Bangladeshi smokers.MethodsData from Wave 2 of the International Tobacco Control (ITC) Survey in Bangladesh, a face to face survey of adult smokers, were analysed. In the ITC survey, households were sampled using a stratified multistage design and interviewed using a structured questionnaire.ResultsOf the respondents (N = 2982), most were male (96 %), married (80 %), and Muslim (83 %); 33 % were illiterate and 54 % were aged below 40. Almost two-thirds were from areas outside Dhaka, 78 % smoked cigarettes exclusively; and 36 % had an intention to quit smoking in the future. This study identified several predictors, comparable to other international studies, of intention to quit smoking: area of residence, number of cigarettes smoked daily, previous quit attempt, visiting a doctor in the past, having child aged 5 or below at home, perceived benefit from quitting, being worried about own health, knowledge of SHS, not enjoying smoking and workplace smoking policy.ConclusionsThese findings suggest that the prevalence of intention to quit smoking is lower among Bangladeshi smokers than those among smokers in developed countries. However, the factors relating to quit intentions among Bangladeshi smokers are comparable to those found in Western countries. Population based tobacco control programs and policies should consider these predictors in the design of interventions to increase quitting among smokers in Bangladesh.

A randomized controlled trial of directive and nondirective smoking cessation coaching through an employee quitline.

BackgroundTelephone quitlines can help employees quit smoking. Quitlines typically use directive coaching, but nondirective, flexible coaching is an alternative. Call-2-Quit used a worksite-sponsored quitline to compare directive and nondirective coaching modes, and evaluated employee race and income as potential moderators.MethodsAn unblinded randomized controlled trial compared directive and nondirective telephone coaching by trained laypersons. Participants were smoking employees and spouses recruited through workplace smoking cessation campaigns in a hospital system and affiliated medical school. Coaches were four non-medical women trained to use both coaching modes. Participants were randomized by family to coaching mode. Participants received up to 7 calls from coaches who used computer assisted telephone interview software to track topics and time. Outcomes were reported smoking abstinence for 7 days at last contact, 6 or 12 months after coaching began. Both worksites implemented new tobacco control policies during the study.ResultsMost participants responded to an insurance incentive introduced at the hospital. Call-2-Quit coached 518 participants: 22 % were African-American; 45 % had incomes below $30,000. Income, race, and intervention did not affect coaching completion rates.Cessation rates were comparable with directive and nondirective coaching (26 % versus 30 % quit, NS). A full factorial logistic regression model identified above median income (odds ratio = 1.8, p = 0.02), especially among African Americans (p = 0.04), and recent quit attempts (OR = 1.6, p = 0.03) as predictors of cessation. Nondirective coaching was associated with high cessation rates among subgroups of smokers reporting income above the median, recent quit attempts, or use of alternative therapies. Waiting up to 4 weeks to start coaching did not affect cessation. Of 41 highly addicted or depressed smokers who had never quit more than 30 days, none quit.ConclusionNondirective coaching improved cessation rates for selected smoking employees, but less expensive directive coaching helped most smokers equally well, regardless of enrollment incentives and delays in receiving coaching. Some subgroups had very low cessation rates with either mode of quitline support.Trial registrationClinicalTrials.gov NCT02730260, Registered March 31, 2016

Utilizing Research to Facilitate Organizational Change

<p><em>This study aimed to facilitate organisational change through research to implement a workplace smoking ban. Previous appeals to the executive management had been unsuccessful, as the health service complied with legal requirements. </em><em>This small exploratory research study, utilized</em><em> the employee survey developed by QUIT Victoria, to gather evidence of staff opinions about workplace smoking.</em><em> Approximately 25% of the workforce smoked. The majority of the workforce in the study supported a workplace smoking ban, citing adverse effects of smoking on them and the environment. Staff also support quit smoking initiatives for staff and a small percentage of those who smoke (27%) reported it would encourage them to quit. Four staff reported that a workplace smoking ban would create difficulties for them, highlighting the importance of support for these staff. A smoke free workplace policy was introduced as a result of the research project. Utilizing a research approach, facilitated positive change for local level workforce and workplace issues.</em></p>

Disparity and Trends in Secondhand Smoke Exposure among Japanese Employees, Particularly Smokers vs. Non-Smokers.

BackgroundMonitoring disparities in secondhand smoke (SHS) exposure is important for tailoring smoke-free policies to the needs of different groups. We examined disparity and trends in SHS exposure among both nonsmokers and smokers at Japanese workplaces between 2002 and 2012.MethodsA total of 32,940 employees in nationally representative, population-based, repeated cross-sectional surveys in 2002, 2007 and 2012 in Japan was analyzed. Adjusted rate ratios for workplace SHS exposure from other people (“everyday” and “everyday or sometimes”) were calculated according to covariates, using log-binomial regression models with survey weights. In this survey, employees who do not smoke at workplace are defined as workplace-nonsmokers; and those smoke at workplace are used as workplace-smokers. SHS exposure for smokers does not involve their own SHS.ResultsWhile everyday SHS exposure prevalence in workplace-nonsmokers decreased markedly (33.2% to 11.4%), that in workplace-smokers decreased only slightly (63.3% to 55.6%). Workplace-smokers were significantly more likely to report everyday SHS exposure than workplace-nonsmokers, and the degree of association increased over time: compared with the nonsmokers (reference), covariates-adjusted rate ratio (95% confidence interval) for the smokers increased from 1.70 (1.62–1.77) in 2002 to 4.16 (3.79–4.56) in 2012. Similar results were observed for everyday or sometimes SHS exposure. Compared with complete workplace smoking bans, partial and no bans were consistently and significantly associated with high SHS exposure among both nonsmokers and smokers. We also observed disparities in SHS exposure by employee characteristics, such as age group and worksite scale.ConclusionsAlthough overall SHS exposure decreased among Japanese employees between 2002 and 2012, the SHS exposure disparity between nonsmokers and smokers widened. Because smokers reported more frequent SHS exposure than nonsmokers, subsequent mortality due to SHS exposure may be higher in smokers than in nonsmokers. This information may be useful for advocating workplace smoke-free policies.

Smoking habits among the hospital staff of a General Hospital in Northern Greece: a long way for smoke-free hospitals

The aim of the study was to evaluate the smoking habits of all staff working in a General Hospital, and to examine whether these habits comply with the introduction of a tobacco law in July 2002, where smoking in enclosed public areas, including hospital buildings, has been forbidden in Greece. All hospital staff in Serres General Hospital was asked to complete and return a questionnaire about their smoking habits. The questionnaire was voluntary and anonymous. The survey was conducted from October 2003 to January 2004. Six hundred and twenty three (74%) of the 847 members of staff responded; 310 (50%) were current smokers and 313 (50%) were non-smokers of whom 101 (32%) were ex-smokers. The prevalence of current smokers was the highest among nurses (57%) and the lowest among doctors (31%). Male smokers (42%) were outnumbered by female smokers (54%) in all age groups up to the age of 60 years (p<0,01), although the reverse is the trend in Greek population (47% and 29%, respectively). The highest rate of smokers was found at the age group of 31-40 years (60%), while these above sixty years had the smallest (29%). Seventy percent of current smokers had at least one family member who was current smoker vs 49% of non-smokers (p<0,001). The vast majority of smokers (94%) continued to smoke in hospital, of whom 62% smoke more than 5 cigarettes while at work. The high rate of smokers among the health professionals compared to those in the general population would probably have a negative influence on the development, implementation and inspection of workplace smoking bans in Greece. Increased efforts to promote tobacco education and intervention among doctors and nurses and to establish specialist smoking cessation services throughout the National Health Service should be the standard component of antismoking policy for the law to be effective.

Suitability of a Group Behavioural Therapy Module for Workplace Smoking Cessation Programs in Malaysia: a Pilot Study

In Malaysia, data on components suitability the established smoking cessation module is limited. This exploratory study aimed to evaluate the suitability of the components developed in the module for group behavioural therapy in workplace smoking cessation programs. Twenty staff were identified but only eight individuals were selected according to the study criteria during the recruitment period in May 2014. Focus group discussion was conducted to identify themes relevant to the behavioural issues among smokers. Thematic analysis yielded seven major themes which were reasons for regular smoking, reasons for quitting, comprehending smoking characteristics, quit attempt experiences, support and encouragement, learning new skills and behaviour, and preparing for lapse/relapse or difficult situations. As a result, the developed module was found to be relevant and suitable for use based on these themes.

Particulate matters from diesel heavy duty trucks exhaust versus cigarettes emissions: a new educational antismoking instrument

Background: Indoor smoking in public places and workplaces is forbidden in Italy since 2003, but some health concerns are arising from outdoor secondhand smoke (SHS) exposure for non-smokers. One of the biggest Italian Steel Manufacturer, with several factories in Italy and abroad, the Marcegaglia Group, recently introduced the outdoor smoking ban within the perimeter of all their factories. In order to encourage their smoker employees to quit, the Marcegaglia management decided to set up an educational framework by measuring the PM1, PM2.5 and PM10 emissions from heavy duty trucks and to compare them with the emissions of cigarettes in an indoor controlled environment under the same conditions.&#x0D; Methods: The exhaust pipe of two trucks powered by a diesel engine of about 13.000/14.000 cc3 were connected with a flexible hose to a hole in the window of a container of 36 m3 volume used as field office. The trucks operated idling for 8 min and then, after adequate office ventilation, a smoker smoked a cigarette. Particulate matter emission was thereafter analyzed.&#x0D; Results: Cigarette pollution was much higher than the heavy duty truck one. Mean of the two tests was: PM1 truck 125.0(47.0), cigarettes 231.7(90.9) p = 0.002; PM2.5 truck 250.8(98.7), cigarettes 591.8(306.1) p = 0.006; PM10 truck 255.8(52.4), cigarettes 624.0(321.6) p = 0.002.&#x0D; Conclusions: Our findings may be important for policies that aim reducing outdoor SHS exposure. They may also help smokers to quit tobacco dependence by giving them an educational perspective that rebuts the common alibi that traffic pollution is more dangerous than cigarettes pollution.

Particulate matters from diesel heavy duty trucks exhaust versus cigarettes emissions: a new educational antismoking instrument.

BackgroundIndoor smoking in public places and workplaces is forbidden in Italy since 2003, but some health concerns are arising from outdoor secondhand smoke (SHS) exposure for non-smokers. One of the biggest Italian Steel Manufacturer, with several factories in Italy and abroad, the Marcegaglia Group, recently introduced the outdoor smoking ban within the perimeter of all their factories. In order to encourage their smoker employees to quit, the Marcegaglia management decided to set up an educational framework by measuring the PM1, PM2.5 and PM10 emissions from heavy duty trucks and to compare them with the emissions of cigarettes in an indoor controlled environment under the same conditions.MethodsThe exhaust pipe of two trucks powered by a diesel engine of about 13.000/14.000 cc3 were connected with a flexible hose to a hole in the window of a container of 36 m3 volume used as field office. The trucks operated idling for 8 min and then, after adequate office ventilation, a smoker smoked a cigarette. Particulate matter emission was thereafter analyzed.ResultsCigarette pollution was much higher than the heavy duty truck one. Mean of the two tests was: PM1 truck 125.0(47.0), cigarettes 231.7(90.9) p = 0.002; PM2.5 truck 250.8(98.7), cigarettes 591.8(306.1) p = 0.006; PM10 truck 255.8(52.4), cigarettes 624.0(321.6) p = 0.002.ConclusionsOur findings may be important for policies that aim reducing outdoor SHS exposure. They may also help smokers to quit tobacco dependence by giving them an educational perspective that rebuts the common alibi that traffic pollution is more dangerous than cigarettes pollution.

Helping people stop smoking in workplaces: an alternative path

Helping people stop smoking in workplaces: an alternative path

Measuring Indoor Air Quality and Engaging California Indian Stakeholders at the Win-River Resort and Casino: Collaborative Smoke-Free Policy Development

Most casinos owned by sovereign American Indian nations allow smoking, even in U.S. states such as California where state laws restrict workplace smoking. Collaborations between casinos and public health workers are needed to promote smoke-free policies that protect workers and patrons from secondhand tobacco smoke (SHS) exposure and risks. Over seven years, a coalition of public health professionals provided technical assistance to the Redding Rancheria tribe in Redding, California in establishing a smoke-free policy at the Win-River Resort and Casino. The coalition provided information to the casino general manager that included site-specific measurement of employee and visitor PM2.5 personal exposure, area concentrations of airborne nicotine and PM2.5, visitor urinary cotinine, and patron and staff opinions (surveys, focus groups, and a Town Hall meeting). The manager communicated results to tribal membership, including evidence of high SHS exposures and support for a smoke-free policy. Subsequently, in concert with hotel expansion, the Redding Rancheria Tribal Council voted to accept a 100% restriction of smoking inside the casino, whereupon PM2.5 exposure in main smoking areas dropped by 98%. A 70% partial-smoke-free policy was instituted ~1 year later in the face of revenue loss. The success of the collaboration in promoting a smoke-free policy, and the key element of air quality feedback, which appeared to be a central driver, may provide a model for similar efforts.

Evaluation of smoke-free policies in seven cities in China, 2007-2012.

China is the world's largest consumer of tobacco, with hundreds of millions of people exposed daily to secondhand smoke (SHS). Comprehensive smoke-free policies are the only effective way to protect the population from the harms of SHS. China does not have a comprehensive national smoke-free law but some local-level regulations have been implemented. To evaluate local level smoke-free regulations across 7 cities in China by measuring the prevalence of smoking in public places (workplaces, restaurants and bars), and support for smoke-free policies over time. Data were from Waves 2 to 4 of the International Tobacco Control (ITC) China Survey (2007-2012), a face-to-face cohort survey of approximately 800 smokers in each of 7 cities in mainland China. Multivariate logistic regression models estimated with generalised estimating equations were used to test the changes in variables over time. As of 2012, over three-quarters of respondents were exposed to smoking in bars; more than two-thirds were exposed to smoking in restaurants and more than half were exposed to smoking in indoor workplaces. Small decreases in the prevalence of smoking were found overall from Waves 2 to 4 for indoor workplaces, restaurants and bars, although the decline was minimal for bars. Support for complete smoking bans increased over time for each venue, although it was lowest for bars. Existing partial smoking bans across China have had minimal impact on reducing smoking in public places. A strongly enforced, comprehensive national smoke-free law is urgently needed in order to achieve greater public health gains.

What is needed to make research on the psychosocial work environment and health more meaningful? Reflections and missed opportunities in IPD debates

What is needed to make research on the psychosocial work environment and health more meaningful? Reflections and missed opportunities in IPD debates

Creating a Representative Sample of Small Manufacturing Businesses for an Integrated Workplace Safety and Smoking Cessation Intervention Study.

We aimed to recruit a representative sample of small manufacturing businesses (20 to 150 employees) for a group-randomized trial of an integrated workplace safety and smoking cessation program. An initial sample was drawn from commercial databases, screened for duplicates or ineligibility, and contacted. Participating and nonparticipating businesses were compared on size, location, and type. Employee demographics of participating businesses were compared to a US Census Bureau database of similar businesses. From an initial sample of 2716 businesses, 328 were eligible and 47 (9%) agreed to participate. Participating companies tended to be larger. They were similar to employees in the Census Bureau dataset. Considerable resources were required to identify eligible businesses; commercial databases are the best resource but may not be comprehensive or current. The sample seemed to be representative of small manufacturing businesses in the study region.

Public responses to a comprehensive smoking ban

Purpose – The purpose of this paper is to report public reactions to a total workplace smoking ban, including smoking behavior, attendance at bars and clubs, and attitudes toward a broader ban. Design/methodology/approach – Surveys were conducted in two adjacent jurisdictions, one of which instituted a total workplace smoking ban. Surveys took place before (n=1,609) and after (n=1,600) enactment of the ban in the relevant jurisdiction. Findings – No change in smoking prevalence occurred in the jurisdiction enacting the ban. Strong majorities of non-smokers supported the ban, while strong majorities of smokers expressed opposition. In the jurisdiction that enacted the ban, smokers who appeared to be high-volume consumers at bars and clubs were most likely to report reducing attendance at these establishments and to oppose the ban. Research limitations/implications – Surveys depend on accurate self-reporting of behavior and attitudes. Practical implications – Some bars and clubs may incur financial losses due to smoking bans. A core of strong opponents can undermine public consensus regarding smoking bans. Licensing a limited number of bars and clubs to allow smoking can safeguard this consensus. Social implications – Limited smoking bans can serve as a means of harm reduction, as non-smokers are protected from environmental tobacco smoke, and accommodation of smokers reduces their motivation to oppose bans. Originality/value – This investigation makes use of detailed data on the public’s thinking and reactions to a comprehensive smoking ban and is a before-after study with controls.

Self-control, future orientation, smoking, and the impact of Dutch tobacco control measures

IntroductionThe pronounced discrepancy between smokers' intentions to quit and their smoking behavior has led researchers to suggest that many smokers are time inconsistent, have self-control problems, and may benefit from external efforts to constrain their consumption. This study aims to test whether self-control and future orientation predict smoking levels and to identify if these traits modify how cigarette consumption responds to the introduction of tobacco control measures. MethodsA sample of Dutch adults (N=1585) completed a measure of self-control and the Consideration of Future Consequences Scale (CFCS) in 2001 and indicated their tobacco consumption each year from 2001 to 2007. In 2004, a workplace smoking ban and substantial tax increase on tobacco was introduced in the Netherlands. To identify the potential impact of these tobacco control measures we examined whether participants smoked or were heavy smokers (20+ cigarettes per day) each year from 2001 to 2007. ResultsParticipants with high self-control and CFCS scores showed lower rates of smoking across the seven year period of the study. The 2004 smoking restrictions were linked with a subsequent decline in heavy smoking. This decline was moderated by self-control levels. Those with low self-control showed a large reduction in heavy smoking whereas those with high self-control did not. The effects were, however, temporary: many people with low self-control resumed heavy smoking 2–3years after the introduction of the tobacco restrictions. ConclusionsThe immediate costs which national tobacco control measures impose on smokers may assist smokers with poor self-control in reducing their cigarette consumption.

Are Partial Workplace Smoking Bans as Effective as Complete Smoking Bans? A National Population-Based Study of Smoke-Free Policy Among Japanese Employees.

Although complete workplace smoking bans are generally recommended rather than partial bans, the latter are widespread in many countries, especially Japan. Our objective was to compare complete workplace smoking bans and partial bans for associations with employee smoking and secondhand smoke (SHS)-related discomfort/ill-health. We also evaluated complete bans versus no ban and partial bans versus no ban. Eleven thousand ninety eligible employees (weighted number: 34 353 241) aged 20-64 years in 2011 (response rate: 62.5%) were analyzed using a nationally-representative, population-based cross-sectional study. Adjusted prevalence ratios for self-reported current smoking and SHS-related discomfort/ill-health according to workplace smoke-free policies were calculated, using conventional regression and propensity score (PS) weighting (targeting population of average treatment effect among both treated [TET] and untreated [TEU]). Both conventional regressions and PS weighting analyses showed complete bans were significantly associated with lower prevalence of current smoking and perceived SHS-related discomfort/ill-health among nonsmokers than partial or no ban. In contrast, partial bans were not significantly associated with either outcome compared with no ban. Using several PS trimming levels, we found interesting differences between TET and TEU in a comparison between partial and no ban: that is, significant associations in TET estimations, but none in TEU estimations. Although complete smoking bans were associated with lower levels of employee smoking and SHS-related discomfort/ill-health compared with no smoking ban, partial bans were not. Findings from PS weighting of TEU suggest that partial workplace bans may not be any more effective for Japanese employees than no ban. Therefore, complete bans may be strongly recommended for future implementation, but careful interpretation of the data is necessary because of the cross-sectional study design.

Inequities in workplace secondhand smoke exposure among nonsmoking women of reproductive age.

We characterized workplace secondhand smoke exposure among nonsmoking women of reproductive age as a proxy for workplace secondhand smoke exposure during pregnancy. We included nonsmoking women aged 18 to 44 years employed during the past 12 months who participated in the 2010 National Health Interview Survey. We estimated the prevalence of workplace secondhand smoke exposure and its associations with sociodemographic and workplace characteristics. Nine percent of women reported workplace secondhand smoke exposure. Prevalence decreased with increasing age, education, and earnings. Workplace secondhand smoke exposure was associated with chemical exposure (prevalence odds ratio [POR] = 3.3; 95% confidence interval [CI] = 2.3, 4.7); being threatened, bullied, or harassed (POR = 3.2; 95% CI = 2.1, 5.1); vapors, gas, dust, or fume exposure (POR = 3.1; 95% CI = 2.3, 4.4); and worrying about unemployment (POR = 3.0; 95% CI = 1.8, 5.2), among other things. Comprehensive smoke-free laws covering all workers could eliminate inequities in workplace secondhand smoke exposure, including during pregnancy.

Work environments and mortality attributable to smoking: a study among male citizens from 2010 to 2012 in Tianjin, China

To analyze the mortality attributable to smoking in different work environments among male citizens in Tianjin, China, and to provide scientific evidence for banning smoking in workplaces and public places. The data of 38 312 male deaths 18-69 years of age in Tianjin from 2010 to 2012 were collected. The risk of death due to lung cancer and cardiovascular diseases attributed to smoking in different work environments was analyzed. Among the male deaths 18-69 years of age in Tianjin, 22.57% were caused by smoking, and the life scan of smokers was shortened by 5 years on average. The smokers who started smoking at an early age and had high dialy cigarette consumption were at high risk of death.The risk of death due to cardiovascular and cerebrovascular diseases among workers in indoor workshop(OR=1.82,95%CI: 1.55 2.15), indoor office personnel (OR=1.59, 95%CI: 1.39-1.81) Indoor public places (OR=1 .55, 95%U: 1.19 2.01) were higher than outdoor workers (OR=1.23,95%CI: 1.12-1.35). The risk of death due to lung cancer among workers in indoor workshop (OR =3.80,95% CI: 3.03-4.76), indoor office personnel (OR =3.04,95% CI: 2.48-3.73) Indoor public places (OR =4.63,95% CI:3.08-6.96)were higher than outdoor workers (OR 2.57,95% CI:2.22-2.97). The risk of death due to lung cancer and cardiovascular diseases among indoor workers was higher than that among outdoor workers. The risk of death due to lung cancer among indoor workers in public places who started smoking when they were younger than 18 years of age was higher than those among outdoor workers and other indoor workers. Smoking is a major risk factor for mortality among male citizens in Tianjin, and also a key factor for the loss of labor productivity. Indoor workers have a higher risk of mortality than outdoor workers. In order to reduce the mortality attributable to smoking, effective actions should be taken as soon as possible to ban smoking in indoor workplaces.

Punching Above Their Weight Through Policy Learning: Tobacco Control Policies in Ireland

Ireland's tobacco control policy today is recognised as one of the strongest in Europe and the world, largely on the basis of its first-in-the-world general workplace smoking ban in 2004. However, it is insufficiently recognised that Ireland has persistently and deliberately developed tobacco control policies since the 1970s, a longer period than most countries. Using a five-fold analysis of factors influencing tobacco policy: agendas, socio-economic setting (including public opinion), networks, institutions, and ideas (including scientific information and diffusion), this paper explains policy development in Ireland over the long term. It demonstrates how a small country, not dependent on tobacco growing or a domestic tobacco industry but also having only a small research and bureaucratic capacity, has managed to create a strong tobacco control policy. Even though it is a European Union member, Ireland has utilised diffusion of research and policy in the English-speaking world, especially paying close attention to the USA, to develop its position as a world policy leader in tobacco control.

Health Behaviors and Overweight in Nursing Home Employees: Contribution of Workplace Stressors and Implications for Worksite Health Promotion.

Background. Many worksite health promotion programs ignore the potential influence of working conditions on unhealthy behaviors. Methods. A study of nursing home employees (56% nursing aides) utilized a standardized questionnaire. We analyzed the cross-sectional associations between workplace stressors and obesity, cigarette smoking, and physical inactivity. Results. Of 1506 respondents, 20% reported exposure to three or more workplace stressors (physical or organizational), such as lifting heavy loads, low decision latitude, low coworker support, regular night work, and physical assault. For each outcome, the prevalence ratio was between 1.5 and 2 for respondents with four or five job stressors. Individuals under age 40 had stronger associations between workplace stressors and smoking and obesity. Conclusions. Workplace stressors were strongly associated with smoking, obesity, and physical inactivity, even among the lowest-status workers. Current working conditions affected younger workers more than older workers. Although this study is cross-sectional, it has other strengths, including the broad range of work stressors studied. Strenuous physical work and psychosocial strain are common among low-wage workers such as nursing home aides. Workplace health promotion programs may be more effective if they include measures to reduce stressful work environment features, so that working conditions support rather than interfere with employee health.