Your role: Get smokers help, address relapses

Occupational health should consider an employee's tobacco dependence as a "chronic relapsing condition," according to the Office of the Surgeon General's Treating Tobacco Use and Dependence clinical practice guideline 2008 update.

"It is likely that you will encounter former smokers who have experienced a relapse," says Linda Sarna, DNSc, RN, AOCN, FAAN, professor and Lulu Wolf Hassenplug Endowed Chair at the University of California — Los Angeles' School of Nursing. "Relapse is very common and needs to be addressed." She gives these recommendations:

• Occupational health professionals shouldn't feel compelled to report this information to human resources, as smokers then wouldn't feel comfortable getting the help they need.

"Smoking is not just a habit, but an addiction that affects the brain," she says. "Additionally, it is difficult to hide smoking, as the smoker's clothing smells. It is very obvious if workers come back from a smoke break."

While colleagues or supervisors may report smokers, this doesn't need to be the role of occupational health. "In any nurse/patient interaction, including the work setting, it is important for the patient to feel comfortable in sharing their health issues," she says. "The law speaks to requirements reporting suspected abuse and sexually transmitted diseases, but not tobacco use."

• Laws about exposure to secondhand smoke should be addressed if employees are smoking in a facility where this isn't allowed.

"This would not just be the responsibility of occupational health, but of others involved in promoting a safe environment," she says.

• In terms of insurance premiums, workers should be the ones held responsible for reporting their health issues honestly.

Employees may be less than forthcoming about many things regarding their health, not just smoking. "There may be work policies about what happens when a worker does not tell the truth about a condition or about smoking," she says. "This would put their own coverage at risk."

• If smokers are not able to get help from occupational health nurses for smoking cessation, this will eliminate the potential benefits of successful programs.

There is a trend toward entire smoke-free campus environments, not just individual buildings, making it very difficult for workers to smoke. When these policies go into place, smokers tend to quit en masse. "Having smoking cessation programs in place is pivotal, if such changes are made," she says.


For more information on the occupational health role in smoking cessation, contact:

• Linda Sarna, DNSc, RN, AOCN, FAAN, Professor and Lulu Wolf Hassenplug Endowed Chair, School of Nursing, University of California, Los Angeles. Phone: (310) 825-8690. Fax: (310) 206-9695. E-mail: