Adapting an integrated occupational safety and health (OSH) and tobacco control intervention for Indian worksites: Insights and opportunities

Background and Objective: In India, occupation is a key determinant of tobacco use disparities with unskilled workers having higher rates of use than skilled workers. Blue-collar workers face a dual health risk due to tobacco use, exposures to occupational hazards and the synergistic effects of the two. Interventions that integrate worker protection and health promotion have been shown to increase cessation in the US, yet few exist in India. Accordingly, we adapted an integrated OSH/tobacco control intervention for manufacturing worksites in Mumbai. This study describes insights and opportunities of adapting it to the Indian setting.

Methods: Formative research was conducted in manufacturing worksites in Mumbai, including focus groups with workers; interviews with management; company site visits; and discussions with Indian OSH and manufacturing associations. An abbreviated intervention was also pilot tested in two worksites.

Results: Most worksites had an OSH infrastructure, which provided a platform for integrating a tobacco control program. Pilot worksites welcomed an assessment of the work environment using a Bureau of Indian Standards Safety Audit checklist and viewed it as an opportunity for strengthening their OSH program. Management also understood the total worker health approach as a way to increase productivity and demonstrate ‘Corporate Social Responsibility' through improved employee health and safety. Additionally, we integrated workers' motivations to be safe, healthy and tobacco-free for their families in the pilot intervention materials.

Conclusions: Conducting formative research and understanding the local context are central to the adaptation process. The Total Worker Health approach holds promise for other countries.