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Social Determinants of Health

The Case of the Reluctant Smoker

Submitted by Bui, Simonetti, Benson, Malek and Anderson
Published June 15, 201

A 52-year-old man with diabetes, hypertension, hyperlipidemia, and COPD presents to your clinic for a routine visit.  He takes 6 medications in addition to 2 inhalers.  He lives with his wife who is disabled from a motor vehicle accident, and they have 2 children in high school. He has smoked 1 pack per day for the past 25 years, but does not drink alcohol.   He is working for a small manufacturing company for almost 20 years, but with the weak economy, he constantly fears losing his job. His diabetes and hypertension are well-controlled. Your major concern for this visit is his continued tobacco use. Repeated efforts to quit smoking by using nicotine gum, patches, and bupropion have not been successful.  He says, “all the guys at work smoke and it’s hard to be the only guy not doing it.”

Which factor listed below would most likely increase his ability to stop smoking?

  1. Educational materials on how to quit smoking

  2. Acupuncture and hypnosis therapy

  3. Long-term use of nicotine replacement therapy

  4. A smoke-free work place

Which action plan would increase his chance of smoking cessation while taking into account his clearly identified workplace obstacles to doing so?

Fast Fact: Smoke-free worksite policies, such as company property smoking bans and coverage of smoking cessation referrals and resources, help employees reduce or discontinue their use of tobacco.  Implementing smoke-free workplace policies was estimated to be more cost-effective than nicotine replacement therapy. Employers may see benefits in improved workplace productivity and decreases in absenteeism.  Some states and municipalities have adopted 100% smoke-free laws in non-hospitality workplaces, restaurants, and bars.    


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Osinubi OYO, Sinha S, Rovner E, Perez-Lugo M, Jain NJ, Demissie K, Goldman M. Efficacy of tobacco dependence treatment in the context of a "smoke-free grounds" worksite policy: A case study. American Journal of Industrial Medicine 2004; 46:180–187

Halpern MT, Shikiar R, Rentz AM, Khan ZM. Impact of smoking status on workplace absenteeism and productivity. Tob Control. 2001; 10(3):233–238

Ong MK, Stanton GA. Free nicotine replacement programs vs implementing smoke-free workplaces: a cost-effectiveness comparison. Am J Public Health 2005; 95(6): 969-975