Reducing social disparities in tobacco use: a social-contextual model for reducing tobacco use among blue-collar workers

Abstract

In the United States in 1997, the smoking prevalence among blue-collar workers was nearly double that among white-collar workers, underscoring the need for new approaches to reduce social disparities in tobacco use. These inequalities reflect larger structural forces that shape the social context of workers' lives. Drawing from a range of social and behavioral theories and lessons from social epidemiology, we articulate a social-contextual model for understanding ways in which socioeconomic position, particularly occupation, influences smoking patterns. We present applications of this model to worksite-based smoking cessation interventions among blue-collar workers and provide empirical support for this model. We also propose avenues for future research guided by this model.

FIGURE 1—

Tobacco control interventions: current practice.

FIGURE 2—

A social-contextual model for tobacco control. Source. This figure is adapted from Sorensen et al. Note. HP = worksite health promotion only; HP/OSH = worksite health promotion plus occupational safety and health.

FIGURE 3—

Results of the WellWorks-2 study: adjusted 6-month quit rates at final assessment by intervention and occupation type (cohort of smokers at baseline: n = 880).