Document Type


Date of Degree

Fall 2017

Access Restrictions

Access restricted until 01/31/2020

Degree Name

PhD (Doctor of Philosophy)

Degree In

Community and Behavioral Health

First Advisor

Parker, Edith A.

First Committee Member

Baquero, Barbara

Second Committee Member

Curry, Susan J.

Third Committee Member

Gilbert, Paul

Fourth Committee Member

Sewell, Daniel

Fifth Committee Member

Sauder, Michael


Smoking cigarettes has a negative impact on the population’s health and on the economy. To reduce the burdens associated with smoking, many workplaces have adopted anti-smoking initiatives (i.e., smoking policies and smoking cessation activities). Unfortunately, smaller workplaces are less likely to have implemented these initiatives, with the likelihood of adoption increasing as the size of the workplace increases. Two characteristics hypothesized to influence anti-smoking initiative adoption are organizational culture and workplace health climate. Culture refers to the values, assumptions, and subconscious norms that operate within an organization, while workplace health climate refers to the shared perceptions of an organization’s practices and priorities for health.

The first study of this dissertation used a qualitative approach to describe and compare the smoking policies and smoking cessation activities at small (20-99 employees) and very small (< 20 employees) workplaces (specific aim 1). Key informants coming from small and very small workplaces (N=32) completed telephone interviews, with data analyzed using content and thematic analysis. Almost all participants (97%, n=31) described a smoking policy at their workplace. A lower proportion of workplaces offered activities to help employees quit smoking (66%, n=21). Reasons for anti-smoking initiative adoption included the implementation of a statewide smoking ban, to improve employee health, and organizational benefits (e.g., reduced insurance costs). Few challenges existed adopting and implementing these activities. Facilitators to adoption and implementation included the passing of a statewide smoking ban, no issues with compliance among employees, and support from others (e.g., management). Compared to small workplaces, very small workplaces were less likely to offer cessation activities. Reasons cited for this lack of adoption included having no current smokers within the organization (i.e., activities not needed) and a lack of interest in quitting among current smokers.

The second study in this dissertation examined the association between organizational culture types and smoking policy strength and smoking cessation activities (specific aim 2), and the associations between organizational culture, workplace health climate, and employee smoking (i.e., smoking status, smoking intensity, and intention to quit smoking) (specific aim 3) at small (20-99 employees) and very small workplaces (< 20 employees). This study conceptualized organizational culture with the Competing Values Framework, which theorizes that four cultural archetypes represent two major dimensions of organizational effectiveness: clan, adhocracy, hierarchical, and market. Executives coming from small and very small workplaces first participated in a brief questionnaire related to their workplace’s anti-smoking initiatives. Executives then sent a link to a separate survey to their employees, which asked questions about organizational culture, workplace health climate, and their smoking behavior. This study used regression analysis to examine associations. The final sample size for analysis was 259 executives and 280 employees coming from 68 workplaces.

Culture was not significantly related to smoking policy strength. An increase in clan culture was associated with lower odds of offering smoking cessation activities (OR=0.09; 95% CI: 0.01, 0.65). Workplaces strong in clan culture did not have a significantly better workplace health climate. A better workplace health climate was associated with lower odds of being a current smoker (OR=0.10; 95% CI: 0.02, 0.57), but was not related to smoking intensity or quit intention.

In consideration of the findings from both studies, the following conclusions were made: 1) the smallest workplaces offer the least protection in relation to tobacco control; 2) state and federal policies are needed to advance tobacco control; 3) organizational characteristics play an important role in shaping behaviors and outcomes related to smoking; 4) integrating organizational change strategies into comprehensive tobacco control initiatives may produce the greatest changes in employee smoking. Action is needed to increase smoking policies and programs at very small workplaces, with strategies designed to change the culture and climate of the workplace implemented.


xiv, 214 pages


Includes bibliographical references (pages 194-214).


Copyright © 2017 Christine Marie Kava

Available for download on Friday, January 31, 2020