Groups of people who are most likely to interact with social workers have extremely high smoking rates. Tobacco harm reduction advocates say that represents a key opportunity for social workers to assist in saving lives.
A recent briefing paper from the Global State of Tobacco Harm Reduction (GSTHR) makes this point. “When appropriately trained and resourced,” it states, “social workers could … play an important part in supporting smoking cessation and tobacco harm reduction with many of the people who need it most.”
But at present, it continues, “few social workers are being trained or supported to address client smoking. Among many competing needs, tobacco use is not often identified as a priority issue.”
Much evidence has documented grossly disproportionate smoking-related harms to marginalized and vulnerable communities, even as smoking rates have shrunk in countries’ general populations.
Across the world, people with mental health conditions, people living in poverty, people in criminal-legal systems and people who use banned drugs, among other groups, smoke at very high rates. Nicotine is important to many in terms of relieving stress and anxiety. Among people experiencing homelessness in both the United Kingdom and the United States, for example, smoking rates have been estimated at a staggering 80 percent. Half or more of people who smoke long-term die of smoking-related causes.
“A basic understanding can help individuals make positive changes.”
David Mackintosh, a director of Knowledge-Action-Change, the organization that publishes GSTHR, pointed out how often members of vulnerable groups meet with social workers seeking help and advice. Among social workers, “a basic understanding of the impact and dangers of smoking alongside the potential of tobacco harm reduction can help individuals make positive changes,” he told Filter.
The briefing paper notes that while social workers’ roles may differ internationally, helping people with problems they face in their daily lives is a global aim. The harms of smoking concern not only individuals’ health but also cascading impacts on finances and family wellbeing, including a higher likelihood of children going on to smoke. So smoking cessation and tobacco harm reduction guidance from social workers “could bring multiple benefits to their client groups.”
Specifically, the paper suggests that social workers could integrate tobacco harm reduction into their work by being “equipped to signpost their clients to local or national smoking cessation support where available.”
It adds that they could be trained in Very Brief Advice for smoking cessation, a brief evidence-based, nonjudgmental intervention for people in health or social care settings. And they could use other psychological tools in which they have expertise, like motivational interviewing or brief cognitive behavioral therapy.
Finally, the paper states, “in countries where safer nicotine products are available and affordable, social workers should be equipped to provide trusted information and advice on tobacco harm reduction options, as part of all-round smoking cessation support.”
“If tobacco smoking is something they want to reduce or stop, that is something I will support.”
But what might social workers, with heavy caseloads and many pressures, think about all this?
“My role as a social worker is to support clients to meet the goals they make,” Colin de Miranda, a clinical social worker in California, told Filter. “If tobacco smoking is something they want to reduce or stop, that is something I will support.”
However, he added that this “is something that will remain sidelined,” when other issues such as his clients’ mental health needs, or homelessness, may be more pressing.
MacKintosh acknowledged that social workers have demanding jobs, and that “they can’t be expected to become experts on every type of safer nicotine product.”
But it might not always require too much extra time, he suggested, when just “knowing that there are ways of using nicotine significantly safer than smoking cigarettes can help them support their clients in taking major steps to improve their health.”
Back when he was unhoused, smoking cessation was never part of the discussion with his social worker, although he would have welcomed it.
One former client is Peter Krykant, who personally experienced the role of social workers at a time when he was made homeless in the UK. “I think when someone wants help to reduce or quit smoking they should be supported to do so,” he told Filter. “Contact with social workers, I think, can present that space and opportunity.”
Krykant, who now works for the charity Cranstoun, supporting marginalized people, was more recently able to quit smoking by switching to vapes. But back when he was unhoused, he said, smoking cessation was never part of the discussion with his social worker, although he would have welcomed it.
In similar contexts, “I am sure that many people would appreciate introductions to [harm reduction] alternatives,” he said. “It would be more beneficial now as well, given the extreme increase in cost for tobacco products.”
“I don’t think the focus should be on how overloaded social workers can better support people [in] reducing their tobacco use,” but rather on “How can society at large shift?”
Yet de Miranda is uneasy with putting much of the onus on professionals who are already juggling multiple harms experienced by their clients.
“I don’t think the focus should be on how overloaded social workers can better support people to move toward reducing their tobacco use,” he said, but rather on “How can society at large shift to support these belittled people to meet their basic needs?”
“I would love to see healthier communities, and reducing tobacco smoking would be a great drop in the bucket,” de Miranda continued. But amid inequalities created by unfettered capitalism, “social workers will only be able to continue to douse the weekly fires lit by our sickly cultures.”
Besides which, equipping professionals with knowledge of tobacco harm reduction doesn’t guarantee that they can transmit it to impacted clients.
“I always try to get methadone patients who smoke to vape,” Dr. Sally Satel, a psychiatrist and lecturer at Yale University School of Medicine, told Filter. “But they have been subjected to so much misinformation that it is hard to convince them that it is safer than smoking.”
Despite that barrier, and despite the heavy burdens already faced by social workers, the harms of smoking to marginalized populations are so vast that they surely deserve focus. Even simply informing a client that vapes are much safer than cigarettes, when most people who smoke don’t know that, has the potential to change someone’s life.
“Integrating tobacco harm reduction into a social work approach to smoking resonates with the aims and motivations of many in the profession.”
Expecting social workers to become more committed to this issue requires providing them with support, resources and training, as the GSTHR paper emphasizes. But for some, there could also be a personal benefit to this focus.
A recent study looked at the issue of health and social care workers in Scotland being exposed to secondhand smoke when they visit clients’ homes—something that participants spoke about in terms of balancing their clients’ rights with their own rights as workers.
Protecting the health of “this often overlooked occupational group” should be a priority, concluded the authors. “Methods such as nicotine replacement therapy and e-cigarettes were identified as potential ways to help people who smoke achieve temporary abstinence prior to a home visit.”
For people who have chosen this work, many of whom support tobacco harm reduction, finding more ways to help others is likely to be the biggest incentive.
“Integrating tobacco harm reduction into a social work approach to smoking resonates with the aims and motivations of many in the profession,” states the GSTHR paper. “Through harm reduction, people who smoke can be empowered to make a positive difference to their health for themselves.”
Photograph (cropped) by Kindel Media via Pexels
The Influence Foundation, which operates Filter, has received restricted grants and donations from Knowledge-Action-Change, which publishes GSTRH. Filter‘s Editorial Independence Policy applies.
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