醫院員工對醫院實施不僱用吸菸者之認知

The Cognitions of Hospital Employee to Non-Smoker Hiring Policy

台灣是全球第51個宣示接受World Health Organization(WHO)Framework Convention on TobaccoCo ntrol，但尚未立法施行WHO「nonsmoker-only」僱用策略。本文探討醫院員工對不僱用吸菸者政策的認知。研究採橫斷性設計，2014年1月藉由線上問卷匿名調查某區域教學醫院員工，自陳吸菸行為（分為有1、無0）、暸解優體保單（分為知道1、不知道0），承受四項無菸政策（不僱用吸菸者、員工健檢包含尼古丁測試、員工懲戒程序、外包員工僱用應遵從無菸要求），採李克特五點尺度（1～5）進行衡量。全院805名員工中448名回覆，回收率52.9%。除描述性分析外，利用多元邏輯斯迴歸分析影響員工是否贊成四項無菸政策之因素。97.1%受試者自陳無吸菸習慣，73.0%有接觸二手菸，14.7%知道優體保單內容。僅22.5%同意不錄用吸菸者，50.0%同意員工健檢（含新人）應通過尼古丁測試，多數（65.6%）同意員工違反無菸納入懲戒，85.5%要求外包商員工遵從無菸環境。有否吸菸、是否知道體優保單、個人特徵對於是否贊成「不僱用吸菸者」及「員工龍成」皆無顯著差異。是否贊成「尼古丁測試」之影響因素，包含男性（勝算比2.136，p=0.046）、年資1-3年（勝算比2.247，p=0.011）、護理職（勝算比3.351，p=0.047），其贊成尼古丁測試的勝算顯著較高；年齡＞40（勝算比0.456，p=0.05）其贊成尼古丁測試的勝算顯著較低。是否贊成「外包員工遵從無菸要求」，有吸菸（勝算比0.176，p=0.015）、有接觸二手菸（勝算0.431，p=0.028）其贊成外包遵從之勝算顯著較低，年資1～3年（勝算比2.708，p=0.018）及5年以上（勝算比3.307，p=0.049）、碩博士（勝算比5.731，p=0.050）其贊成外包遵從之勝算較高。僅有少數員工認為醫院有權利拒絕聘僱吸菸者，建議欲實施無菸政策的醫院應評估員工吸菸行為和態度，當員工普遍接受可降低吸菸行為的政策，再漸進採取反菸雇用。為配合WHO政策，初探結果供參酌。

Taiwan is the 51^(st) country declaredly accepted the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) in the world while has not yet proposed legislation to implement ＂nonsmoker- only＂ hiring. We explore the employees’ cognitions toward ＂smoke-free hospital＂ strategies. A cross-sectional study was conducted at a teaching regional hospital in Jan 2014 by online questionnaire anonymous survey. Employees self-reported personal demographic characteristics, smoking habits and second hand smoking exposure categorically rated as 1 (yes) and 0 (no), and attitudes about the smoke-free policy rated on a five-point Liker scale from strongly disagree (1) to strongly agree (5). 805 staff totally, 448 valid questionnaires were returned, for a response rate of 52.9%. Besides description statistics, we used multivariate logistic regression to analyze underlying factors affecting employees’ attitudes toward supporting implementation of smoking free policy. 97.1% of employees self-reported that they are no smoking and 73.0% reported no exposure to second-hand smoking. 14.7% reported they have understood ＂excellent body policy＂ in insurance companies (such as a reduced health insurance premium 50% for not smoking). Furthermore, 50.0% thought employees or new applicants for job should be tested for nicotine. Only 22.5% agreed to implement the non-smoking hiring. We found that there is no significant effect of smoking habit on employees' attitudes toward ＂non-smoker only hiring policy＂ and ＂take disciplinary action against smoking＂. Regarding associated factors supporting implementation of ＂nicotine test of health examine＂ for employees or new comer, male (OR=2.136, p=0.046), employees with tenure of 1~3 years (OR=2.247, p=0.011)、nurse group (OR=3.351, p=0.047)) and were more supportive. Employees with smoking habit (OR=0.176, p =0.015) were more likely to be agree that ＂outsourced worker should comply with smoke-free environment＂. Those with tenure of 1~3 years (OR=2.708, p=0.018), more than 5 years (OR=3.307, p=0.049), with PhD and master degree group (OR=5.731, p =0.050) were more supportive. Most employees believed that hospitals did not have a right to refuse to hire a smoker. Hospitals considering employment restrictions policies should institute new policies gradually and with employee input.