Smoking and Unemployment: A Photo Elicitation Project.

INTRODUCTION: Research has documented higher smoking prevalence with unemployment and greater difficulty with gaining re-employment for those who smoke. Using photo elicitation methods, we sought to gain a deeper understanding of the connection between job-seeking and tobacco use. METHODS: Unemployed daily smokers (18 men, 1 woman) were recruited from the San Francisco Employment Development Department (EDD) and provided disposable cameras with 27 exposures and a list of 20 photo prompts related to job-seeking and tobacco. Study staff reviewed the photos with the participants and audio-recorded their narratives. The photos and narratives were coded for themes. RESULTS: Of 363 photos, the most frequent photo imagery related to transportation (n = 56, 15.4%), work or education (n = 39, 10.7%), and littered cigarettes (n = 39, 10.7%). Narrated themes centered on motivators to quit smoking (255 mentions from 15 participants); people, places, and things associated with smoking (248 mentions, 16 participants); and motivators to secure work (157 mentions, 13 participants). The intersection of smoking and unemployment received 92 mentions from 11 participants, with 60 mentions (8 participants) identifying smoking as a barrier to re-employment. CONCLUSIONS: Both motivators to quit and associated smoking cues were salient in the environments of job-seeking smokers. Struggles with quitting and perceptions that smoking is harming re-employment success suggest the potential for offering tobacco treatment in EDD settings. With permission, the photos and themes have been incorporated into a tobacco treatment intervention for job-seeking smokers.

Likelihood of Unemployed Smokers vs Nonsmokers Attaining Reemployment in a One-Year Observational Study.

IMPORTANCE: Studies in the United States and Europe have found higher smoking prevalence among unemployed job seekers relative to employed workers. While consistent, the extant epidemiologic investigations of smoking and work status have been cross-sectional, leaving it underdetermined whether tobacco use is a cause or effect of unemployment. OBJECTIVE: To examine differences in reemployment by smoking status in a 12-month period. DESIGN, SETTING, AND PARTICIPANTS: An observational 2-group study was conducted from September 10, 2013, to August 15, 2015, in employment service settings in the San Francisco Bay Area (California). Participants were 131 daily smokers and 120 nonsmokers, all of whom were unemployed job seekers. Owing to the study's observational design, a propensity score analysis was conducted using inverse probability weighting with trimmed observations. Including covariates of time out of work, age, education, race/ethnicity, and perceived health status as predictors of smoking status. MAIN OUTCOMES AND MEASURES: Reemployment at 12-month follow-up. RESULTS: Of the 251 study participants, 165 (65.7) were men, with a mean (SD) age of 48 (11) years; 96 participants were white (38.2%), 90 were black (35.9%), 24 were Hispanic (9.6%), 18 were Asian (7.2%), and 23 were multiracial or other race (9.2%); 78 had a college degree (31.1%), 99 were unstably housed (39.4%), 70 lacked reliable transportation (27.9%), 52 had a criminal history (20.7%), and 72 had received prior treatment for alcohol or drug use (28.7%). Smokers consumed a mean (SD) of 13.5 (8.2) cigarettes per day at baseline. At 12-month follow-up (217 participants retained [86.5%]), 60 of 108 nonsmokers (55.6%) were reemployed compared with 29 of 109 smokers (26.6%) (unadjusted risk difference, 0.29; 95% CI, 0.15-0.42). With 6% of analysis sample observations trimmed, the estimated risk difference indicated that nonsmokers were 30% (95% CI, 12%-48%) more likely on average to be reemployed at 1 year relative to smokers. Results of a sensitivity analysis with additional covariates of sex, stable housing, reliable transportation, criminal history, and prior treatment for alcohol or drug use (25.3% of observations trimmed) reduced the difference in employment attributed to smoking status to 24% (95% CI, 7%-39%), which was still a significant difference. Among those reemployed at 1 year, the average hourly wage for smokers was significantly lower (mean [SD], $15.10 [$4.68]) than for nonsmokers (mean [SD], $20.27 [$10.54]; F(1,86) = 6.50, P = .01). CONCLUSIONS AND RELEVANCE: To our knowledge, this is the first study to prospectively track reemployment success by smoking status. Smokers had a lower likelihood of reemployment at 1 year and were paid significantly less than nonsmokers when reemployed. Treatment of tobacco use in unemployment service settings is worth testing for increasing reemployment success and financial well-being.

Health-related quality of life among veterans in addictions treatment: identifying behavioral targets for future intervention.

BACKGROUND: US veterans report lower health-related quality of life (HRQoL) relative to the general population. Identifying behavioral factors related to HRQoL that are malleable to change may inform interventions to improve well-being in this vulnerable group. PURPOSE: The current study sought to characterize HRQoL in a largely male sample of veterans in addictions treatment, both in relation to US norms and in association with five recommended health behavior practices: regularly exercising, managing stress, having good sleep hygiene, consuming fruits and vegetables, and being tobacco free. METHODS: We assessed HRQoL with 250 veterans in addictions treatment (96 % male, mean age 53, range 24-77) using scales from four validated measures. Data reduction methods identified two principal components reflecting physical and mental HRQoL. Model testing of HRQoL associations with health behaviors adjusted for relevant demographic and treatment-related covariates. RESULTS: Compared to US norms, the sample had lower HRQoL scores. Better psychological HRQoL was associated with higher subjective social standing, absence of pain or trauma, lower alcohol severity, and monotonically with the sum of health behaviors (all p < 0.05). Specifically, psychological HRQoL was associated with regular exercise, stress management, and sleep hygiene. Regular exercise also related to better physical HRQoL. The models explained >40 % of the variance in HRQoL. CONCLUSIONS: Exercise, sleep hygiene, and stress management are strongly associated with HRQoL among veterans in addictions treatment. Future research is needed to test the effect of interventions for improving well-being in this high-risk group.