Tobacco-Cessation Programs: Healthier Lives—and Bottom Lines

By Stephen Miller Mar 1, 2008
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Cigarette smoking is the top preventable cause of death in the United States, according to the federal Centers for Disease Control. Tobacco use leads directly to the No. 1 killers: heart disease, cancer (lung and throat from smoking; mouth, throat and stomach from smokeless tobacco), stroke, and chronic respiratory disease.

"Tobacco kills more people in the U.S. each year than alcohol, cocaine, crack, heroin, AIDS, suicide, automobile accidents and fires combined," stressed Eduardo Sanchez, chairman of the National Commission on Prevention Priorities, as he addressed the 3rd Annual Employer Health & Human Capital Congress, held January/February 2008 in Washington, D.C.

Sanchez, also director of the Institute for Health Policy at the University of Texas School of Public Health, described how providing tobacco-cessation programs can improve employee health and save lives, while cutting health care dollars and improving employers' bottom lines.

Policies that have proved effective, he noted, typically include:

  • Mandating a smoke-free workplace, and creating a "culture of quitting" with effective marketing and messaging.
  • Encouraging employee health risk appraisalsand tobacco counseling from their physician.
  • Providing access to telephone "quit lines."
  • Covering pharmacological therapy on a first-dollar basis.
  • Eliminating co-pays for cessation-related expenses and, when feasible, providing other incentives.
  • Behavior change support through employee recognition and (when possible) financial incentives, along with personal progress surveys, are also factors for a successful program.

High ROI

As an indication of the return on investment to employers from such efforts, Sanchez cited research by the Center for Health Research, Kaiser Permanente Northwest, revealing that:

  • Smokers incur $1,600 a year more in health-care costs.
  • By year five of an employer-funded tobacco-cessation program, benefit savings are almost twice the program cost.

Creating a Quitting Culture

Ann Skye, the manager of employee wellness at pharmaceutical services firm Quintiles Transnational Corp, told the conference how a tobacco-cessation program she helped put in place builds on all of the key points outlined by Sanchez.

For example, at Quintiles, the program includes:

  • American Cancer Society Quitline, a 24/7 telephone hotline.
  • Trained counselors.
  • Nicotine replacement therapy.
  • Over the counter and prescription t-cessation medications for employees, covered spouses, partners and dependents paid for in full.
  • No co-pay for physician-provided tobacco-cessation counseling.
  • On-site group-based "QuitSmart" classes, paid for in full.
  • Tobacco-free workplace policy.
  • Employee recognition program.

To spur participation in tobacco-cessation programs, effective messaging and employee recognition as part of a "quitting culture" are vitally important, Skye noted. (This is especially true in companies with a unionized workforce subject to collective bargaining agreements, where employers may lack the ability to offer monetary incentives, including health care premium reductions).

At Quintiles, Skye says, "We are creating a culture that celebrates success in quitting. We have certificates available for participants to post, signed by our chief medical officer. We also have a wellness web site with inspirational stories for those who want to share their quitting experience with others."

In addition, "We send postcards to the home so that spouses and dependents are aware of the Quitline. We also provide full, no-cost coverage to prescription tobacco-cessation medications for covered spouses and dependents as well.”

Skye reported the following timeline and metrics from Quntiles' program:

Timeline:

  • Tobacco-free initiative introduced at launch of wellness program in September 2006. By self-report, around 12 percent of employees used tobacco at baseline.
  • Tobacco-cessation services in place Jan. 1, 2007.
  • Tobacco-free workplace implemented July 4, 2007.
  • Tobacco-free workplace expectations incorporated into recruitment and onboarding processes, third quarter 2007.

Program Outcomes

July 2007 online survey:

  • 6 percent of employee tobacco users quit between program launch and tobacco free workplace implementation.
  • 49 percent of these quit "cold turkey" (including one high-level executive).
  • 22 percent used prescription meds with or without counseling.
  • 14 percent used nicotine replacement therapy with or without counseling

December 2007 online survey:

  • 10 percent of employees use tobacco (down 2 percent from baseline).
  • 6 of 10 have plans to quit.
  • Goal for 2008 year end: 8 percent tobacco use rate.
  • Goal for 2009 year end: 5 percent tobacco use rate.

At the start, "We had a lot of spirited debate among our employees," Skye said, "but high acceptance as well for both the services and the tobacco-free policy." All in all, she reflected, getting underway and reaping the rewards of better employee health and cost savings "was much easier than we anticipated it would be."

Partnership for Prevention web site provides many helpful resources for launching a smoking-cessation program, including:

Another helpful site is the American Legacy Foundation, where resources include:

Finally, to receive additional information and resources on this topic, visit:

Stephen Miller is manager of SHRM Online's Compensation & Benefits Focus Area.

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