Business of Well-being

From Policy to Outcomes: How One Employer Reduced Tobacco Use Among Employees

Despite a steady reduction in the prevalence of adult cigarette smokers in the United States, tobacco use remains the leading cause of preventable death. Smoking causes serious health issues including cancer, heart disease and respiratory diseases, which lead to billions of dollars in health care costs and lost productivity annually.

In fact, with smoking breaks alone, the average smoker works one month less per year than nonsmokers. This evidence, combined with a goal to implement a supportive, employee-friendly way to improve employee health and decrease health costs, led one North Carolina health plan to establish an internal smoking cessation program and become a tobacco-free workplace in 2005.

The company, with more than 4,000 employees at four locations across North Carolina, hired a wellness coordinator in 2004 and devoted a small budget to employee wellness as part of an overall worksite wellness program. At the time, the company offered onsite gyms, an employee health clinic and free nutritional counseling for employees, but smoking was still allowed in designated areas outside each building.

When a 2004 study showed that implementing a tobacco-free campus led to an increase in employee quit rates, the company's leadership team implemented a policy prohibiting employees from using tobacco on any of the company's properties and designated the organization as a tobacco-free workplace beginning on the Great American Smokeout, November 17, 2005.

The company knew that a supportive environment was essential to fostering a corporate culture of health and wellness. The company utilized internal clinical resources and best practices from national organizations such as the Centers for Disease Control and Prevention, the National Business Group on Health, the American Lung Association as well as other local organizations with tobacco-free worksites to develop the new policy, communication plan, and cessation resources.

Employee communication began nearly nine months before the new policy went into effect. The company posted signs in the smoking areas informing employees that the campus would become tobacco-free in November. They also relied heavily on emails from senior leadership and postings on the company Intranet to communicate why the worksite was becoming tobacco-free and what resources were available to help employees quit tobacco.

Studies have shown that combining tobacco cessation counseling with medication is more effective in helping smokers quit and remain tobacco-free than either medication or counseling alone. Based on this evidence, the company offered its employees three options for onsite cessation counseling and treatment, all at no cost to the employee:

  1. Eight-week, onsite Freedom from Smoking classes led by an American Lung Association facilitator.
  2. Physician appointments in the employee health center.
  3. Counseling with specially-trained pharmacists from a regional pharmacy retailer.

Employees who attended all Freedom From Smoking classes received a complete set of free NicoDerm CQ patches. Employees who met with the physician or pharmacist received a free starter kit of NicoDerm CQ. To cover additional cessation costs, the company provided additional support in the form of a $250 reimbursement for medication or outside counseling.

In 2005, almost 21 percent of American adults were smokers, and in the tobacco-farming state of North Carolina, the rate was even higher at 22.6 percent. From the annual health risk assessment, the company estimated its 2005 employee smoking rate was approximately 15 percent. This number may have been higher because the health risk assessment was not mandatory and the information was self-reported by employees.

Biometric screenings were introduced in 2007, after the company implemented a tobacco-free worksite and created a policy prohibiting the use of tobacco on all property. In addition to the standard measurements of body mass index (BMI), blood pressure, glucose and cholesterol, the screenings also included cotinine, a measure of nicotine in the blood.

Participation in the screening and health risk assessment were tied to a premium incentive of $250 and over 85 percent of employees completed both. Two years after implementing a tobacco-free campus and offering multiple tobacco cessation programs, the company's employee tobacco use rate fell to 13 percent.

Over the next three years, the company continued to support tobacco cessation through its employee health clinic, a $250 reimbursement program for nicotine replacement therapy or quit classes, and health plan benefits that covered tobacco cessation counseling and prescription medications. As a result, the employee tobacco use rate remained stable.

One year later, the company transitioned from a participation-based reward program to one that rewarded employees based on desired health outcomes. According to a 2010 Hewitt Associates survey of 600 large U.S employers, 47 percent currently, or planned to within the next five years, impose financial penalties for employees who engage in unhealthy behaviors; the majority of those surveyed target smokers.

In early January 2011, the company announced that employees who used tobacco would be required to pay an additional $250 for health insurance if they did not quit in the nine months prior the biometric screenings in September. Smokers were still offered support programs to help them quit, and employees could still earn a significant discount on health insurance premiums by participating in the biometric screening, health risk assessment and other wellness activities.

Tying an unhealthy behavior to one's wallet led to a dramatic decline in the company's tobacco use rate. The company's employee smoking rate fell more than three percentage points to 8.6 percent, well below the 2010 North Carolina adult smoking rate of 19.8 percent and the U.S. rate of 17.3 percent.

The success of an employee-friendly tobacco cessation program is largely dependent upon the company's commitment to making a cultural decision to implement environmental and policy changes and, once established, offering employees subsidized or free medical help to quit tobacco use.

With this structure in place, the company's $250 incentive for employees to quit smoking resulted in a dramatic decline in use rates and paved the way for the company to implement a tobacco surcharge years later with relatively little employee unrest. Because of these policy and environmental changes, the company reduced its employee tobacco use rate by more than six percentage points.

By investing into a company wellness program that supports the improvement of employee health, companies can help reduce medical costs associated with smoking such as cancer, heart disease and respiratory disease. Additionally, employees who quit smoking will not take smoking breaks, leading to higher productivity in the office. This company's experience serves as evidence that providing the appropriate resources and support to employees to quit smoking can lead to significant savings and lay the groundwork for a healthier employee population.


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About The Author

As a healthcare consultant, Weaver works collaboratively with client employer groups to conduct trend analytics, optimize their benefit design and support their overall health strategy. The former wellness manager for BCBSNC's employee wellness program, Anne led the effort for BCBSNC to become one of the first tobacco-free worksites in North Carolina.

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