摘要：Objectives. This study determined the level of insurance coverage for smoking cessation treatment and factors associated with coverage among health and welfare funds affiliated with a large labor union. Methods. A self-administered written survey was mailed to fund and union officials. Analyses were conducted by χ2 tests. Results. Twenty-nine percent of funds provided coverage for some type of smoking cessation treatment, with the odds of coverage significantly increased among funds whose administrators reported having received members' requests for smoking cessation treatment in the past year (odds ratio = 4.9, P = .05). Conclusions. Coverage for smoking cessation services is low, comparable to coverage offered by other health insurers. Interventions with union members and fund officials are needed to provide union members with access to affordable and effective smoking cessation treatments. Class-based disparities in tobacco use are increasing. The gap in smoking prevalence by occupational category has been steadily widening, with blue-collar workers (defined by census occupational categories 401–785 as craftsmen/kindred workers, operatives, and laborers) 1 , 2 being more likely to smoke, to smoke more heavily, and to be less successful in quitting smoking than either white-collar or service workers. 1 – 4 In 1997, 36% of blue-collar workers were smokers, compared with 21% of white-collar workers, with occupational class remaining a significant predictor of smoking after age, sex, and race/ethnicity were controlled for. 1 Decades of tobacco control efforts have met with limited success among these workers, suggesting that new strategies and community partners are needed. Labor unions are a natural ally in such efforts, in that they are likely to represent workers in these at-risk occupations and because many unions offer health insurance to their members. 5 Through their health insurance programs, unions can offer fully paid coverage of smoking cessation services, a benefit that has been shown to be effective in other insured populations. 6 Health insurance is provided by some unions to their members through health and welfare (Taft–Hartley) funds. These funds are financed by contracting employers' contributions to regional funds on behalf of their unionized employees under terms negotiated in the collective bargaining process, which is based on the National Labor Relations Act. The funds either purchase health insurance or self-insure. They are governed equally by representatives from labor and management and operated at regional or district levels. It is estimated that health and welfare funds provide health insurance coverage to approximately 9 million smokers in the United States. 7 These funds are therefore a unique vehicle for increasing labor union members' access to affordable smoking cessation services, which may, in turn, redress class-based disparities in smoking prevalence. In this article, we report the findings of a survey of health and welfare funds affiliated with the Laborers' International Union of North America (LIUNA), which represents approximately 800 000 construction, health care, service, public sector, and environmental laborers in the United States. We determined the level of coverage for smoking cessation services by health and welfare funds; we also tested for associations between coverage and (1) survey respondents' perceptions of members' smoking as a problem, (2) their level of concern about it and its potential impact on the health and welfare fund, and (3) the number of member requests for coverage of smoking cessation services.
