The Florida Department of Health recently awarded more than $1.4 million from the James and Esther King Biomedical Research Program to Taghrid Asfar, M.D., at Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, to help construction workers quit smoking.
Dr. Asfar and colleagues will develop new ways to enhance construction workers' access to smoking cessation information and treatment, study those interventions in the field, and determine which approaches are the most cost effective and scalable.
Construction workers have the highest smoking rates among all occupations, almost double the rate of the general population, and half of them belong to low-income racial and ethnic minorities. They are also exposed to workplace toxins that interact with smoking and increase their risk of lung cancer and chronic lung disease. We need better ways to help them quit."
Dr. Taghrid Asfar, Associate Professor in the Division of Epidemiology and Population Health Sciences in the Department of Public Health Sciences
There are many reasons construction remains an outlier. Because of their high mobility, construction workers often lack access to health promotions and cessation services. Even if they want to quit smoking, workers may not have access to cessation programs tailored to their work and life circumstances.
In addition, construction is dangerous and stressful work, and the outdoor sites can make it difficult to implement the smoking cessation programs that have so successfully helped office workers quit.
Builds on earlier smoking cessation program
Dr. Asfar, who was named Sylvester's Outstanding Population Science Researcher in 2022, has been studying this problem for nearly a decade. As part of a 2014 grant from the National Cancer Institute (NCI), Dr. Asfar, David Lee, Ph.D., and Alberto Caban-Matinez, Ph.D., D.O., M.P.H., conducted a pilot smoking cessation program focusing on Hispanic construction workers. Lessons from that study are being applied to the current grant.
"We partnered with construction company leaders and safety managers to help access these workers," said Dr. Asfar. "The safety managers are particularly important; they're essentially the gatekeepers."
Safety managers meet daily with their teams to address work-related safety issues and remedies. The researchers simply piggyback on these meetings to provide access to smoking cessation information. In addition, Dr. Asfar's researchers will make themselves available around the ubiquitous food trucks to follow up with interested workers.
"This is where we meet and talk to them and provide the smoking cessation treatment," she said. "Everything is done around the lunch truck."
The new study will train safety managers to provide and test three intervention levels to determine which approaches are the most successful and cost-effective. The minimal intervention offers nicotine replacement treatment to reduce withdrawal symptoms and refers workers to the Florida Tobacco Quitline.
The second level, which was developed in 2014 for the NCI study, augments the basic approach with group counseling, providing 30-minute sessions for small groups. For this project, the researchers added a third level, which includes four counseling sessions, each focused on a different aspect of quitting.
The study will be an enormous undertaking and will bring in Dr. Asfar, Dr. Lee, and Kathryn McCollister, Ph.D., of the Miller School, along with researchers from the University of Florida and Florida International University. The ultimate goal is to develop the most cost-effective approaches and scale them to reach as many workers as possible.
"At the end of the project, we will share our data with company leaders and show them how much each level will cost them, as well as the payoffs in smoking cessation, which could reduce health insurance and other costs," said Dr. Asfar. "Ultimately, we want them to implement and offer free smoking cessation services delivered onsite by the safety managers for all construction workers."
Quitting smoking after cancer diagnosis can add years to patient lives