FDA Center for Tobacco Products
WHO Framework Convention on Tobacco Control
TReND: Exploring Organizational, Cultural, and Individual Barriers Associated with the Utilization of a Worksite Tobacco Cessation Program
Visit TReND’s web portal www.tobaccodisparities.org
to learn more about research, programs, policies, and resources relevant to tobacco and health disparities.
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About the Project
Rationale: Few studies have examined how race/ethnicity, socioeconomic status, and geography influence smoking quit rates and the participation of persons with these multiple characteristics in cessation programs. African Americans in Kentucky have the second highest smoking rate compared to all other racial/ethnic groups. Kentucky, which is largely rural, has the highest rate of smoking and low rates of quitting compared to other states. Furthermore, studies show that blue-collar workers have higher smoking and lower quit rates compared to white collar workers. To date, no published studies have identified employer-based strategies to help African American/blue collar/rural Kentucky workers quit smoking.
Purpose: The purpose of this study is to employ a social ecological approach and use participatory and qualitative research methods in a manufacturing company in rural Kentucky to identify factors related to successful implementation and use of an employee smoking cessation program among African-American and/or rural blue-collar workers. Specifically, TReND’s investigators will:
- identify multiple cultural influences on employee participation and development of cessation programs in an automobile manufacturer in rural Kentucky;
- assess the organizational and individual variables that influence the implementation and participation of blue-collar workers in a tobacco cessation program;
- explore how social ecological factors influence quitting and participation in quitting programs among blue collar-African American-rural-Kentucky workers; and
- examine the interconnection of education, occupation, income and race on the utilizations and knowledge of smoking cessation methods among diverse populations within a worksite.
This pilot research study will also help us answer the following research questions: What are the best strategies for engaging African-American employees in qualitative research strategies? What variables can be input into a theoretical model that will help guide the development of a cessation intervention that is culturally relevant?
Impact: This exploratory case study of a foreign owned company in rural Kentucky with over 10,000 workers has the potential to expand our knowledge base considerably concerning the differences in the smoking cessation process among African-American blue-collar workers and the role of culture and social context in the process of quitting smoking for this population and their families.
Research Team
Linda Alexander, EdD (Principal Investigator)
University of Kentucky
Charlotte Baker
University of Kentucky, DrPH (candidate), MPH
Nan Banks
Toyota Motor Manufacturing, Kentucky, Inc.
Ford Brewer, MD, MPH
Toyota Motor Manufacturing, Kentucky, Inc.
Francisco Buchting, PhD
ETR Associates
Ronnie Deskins
Toyota Motor Manufacturing, Kentucky, Inc.
Pebbles Fagan, PhD, MPH
National Cancer Institute
Peace Jessa, MD, DO, PharmD, MPH
Toyota Motor Manufacturing, Kentucky, Inc.
Deidre Lawrence, PhD, MPH
National Cancer Institute
Gregory Robbins, MD
Toyota Motor Manufacturing, Kentucky, Inc.
Allison Rose, MHS
SAIC-Frederick, Inc.
Vickie Shavers, PhD
National Cancer Institute
Contact Us
Principal Investigator
Linda Alexander, EdD![]()
Associate Dean, Associate Professor
Department of Health Behavior
College of Public Health
University of Kentucky
lindaalex@uky.edu
Project Activities and Findings
NCI and Toyota Engineering and Manufacturing Collaborative Meeting: Why and How to Go Smoke-Free (April 2008). National Cancer Institute, Bethesda, MD. Agenda and Participant List.
Resources provided during the meeting can be accessed below under Other Resources and Publications.
Company Milestones Resulting from TReND Collaboration
- Cigarettes removed from all vending machines.
- Launched Health and Wellness Series at both manufacturing and management sites.
- Cigarette butt-clean and the reduction of smoke areas take priority in 2009.
(Not yet available.)
Alexander LA (September 2010). Get ready, get set, get healthy. The African American Collaborative (AAC) and The University of Kentucky College of Public Health. Erlanger, Kentucky.
Alexander LA (June 2009). Toyota worksite wellness. Tobacco Research Network on Disparities (TReND) Meeting, National Cancer Institute, Bethesda, MD.
Alexander L, Baker C, Butler M (November 2010). Barriers to blue collar worker utilization of employer sponsored smoking cessation programs. Presentation at the 138th American Public Health Association Annual Meeting and Expo
, Denver, CO.
Alexander LA, Hartsfield A, Jessa P (September 2008). Thinking beyond your current circumstances: Mind, body and soul. Toyota, Georgetown, Kentucky.
Other Resources and Publications
Health Effects of Secondhand Smoke
U.S. Department of Health and Human Services (2006). Surgeon General’s Report on the Health Consequences of Involuntary Exposure to Second-hand Smoke. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Atlanta, GA.
Centers for Disease Control and Prevention (2006). Consumer Summary of the Surgeon General’s Report on the Health Consequences of Involuntary Exposure to Second-hand Smoke: Secondhand Smoke, What It Means To You.
Centers for Disease Control and Prevention Fact Sheets on Secondhand Smoke.
NCI and NIH Smoke-Free Policies
NCI’s Smoke-Free Meeting Website and Policy
NIH Tobacco-Free Campus: What is Tobacco-Free NIH? and Tobacco-Free Campus Policy
Resources for Going Smoke-free at the Worksite
Burns DM, Shanks TG, Major JM, Gower KB, Shopland DR (2000). Restrictions on Smoking in the Workplace. Chapter 3 in NCI Monograph 12: Population Based Smoking Cessation: Proceedings of a Conference on What Works to Influence Cessation in the General Population. Smoking and Tobacco Control Monograph No. 12. Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute, NIH Publication No. 00-4892.
U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Office on Smoking and Health in collaboration with the Wellness Councils of America and American Cancer Society. Making Your Workplace Smokefree: A Decision Maker’s Guide.
Centers for Disease Control and Prevention: Implementing a Tobacco-Free Campus Initiative in Your Workplace, Toolkit.
Centers for Disease Control and Prevention: Save Lives, Save Money: Make Your Business Smoke-Free
State Worksite Smoke-Free Laws and Tobacco Control Efforts
American NonSmokers’ Rights Foundation: Going Smoke-Free
and Smoke-free Lists, Maps, and Data![]()
- U.S. 100% Smokefree Laws in Workplaces AND Restaurants AND Bars

- Municipalities with Local 100% Smokefree Laws

American NonSmokers’ Rights Foundation: Adopt a Smoke-Free Cities Meeting Resolution!![]()
U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Sustaining State Programs for Tobacco Control, Data Highlights, 2006
The National Cancer Institute (NCI) and American Legacy Foundation are proud to fund the Tobacco Research Network on Disparities (TReND). Previous support has also been provided by the Department of Health and Human Services (DHHS) Office on Women’s Health, NCI Office of Women’s Health, and the NCI Center to Reduce Cancer Health Disparities.




