Ever since the first Surgeon General's report was released nearly 50 years ago, the medical and financial consequences of tobacco use have become widely known. Yet, despite the fact that more than half of U.S. states now ban smoking in workplaces, restaurants and bars, one in five adults continue to smoke regularly. Indeed, more than 360 billion cigarettes are smoked in the U.S. every year.
This persistence of tobacco use obliges employers to understand how smoking affects the well-being and productivity of their workforce, and to take action. With rising health care costs high on the CEO agenda, executives should firmly embrace innovative smoking cessation programs which can help their employees who smoke to quit the habit.
Grim Data
The statistics are grim. According to the 2010 U.S. Surgeon General report, cigarettes are responsible for approximately 443,000 deaths - 1 in every 5 deaths - each year in the U.S. The economic toll is also high. More than $193 billion annually in health care costs and productivity losses is attributable to cigarette use. Smokers are also far more likely to suffer from chronic diseases, such as atherosclerosis - the buildup of fatty substances in the arteries - than are nonsmokers.
In short, tobacco use is the largest cause of preventable illness and death. Smokers miss an average of 6.16 days of work each year due to sickness, compared with 3.86 days for non-smokers. Not surprisingly, smokers visit health care facilities far more often than non-smoking employees, have more hospital admissions, and stay in the hospital for longer periods on average.
Of course, the harmful effects of smoking also impinge on others. Thousands of nonsmokers are adversely affected and may die from heart disease and lung diseases, including lung cancer every year because of exposure to secondhand smoke.
New Urgency.
The need for employers to address tobacco use has taken on new urgency recently. According to the Surgeon General's report, the way that tobacco is grown, mixed and processed today has caused cigarettes to become more addictive than ever before - making it even tougher for smokers to quit. Because chronic tobacco use in an intensely ingrained behavior, repeated interventions are often required for cessation efforts to be successful.
But effective remedies exist. The Centers for Disease Control (CDC) declares tobacco cessation treatment as the "single most cost-effective health insurance benefit (for employees)". A study of 1,450 adults conducted in 2010 by OptumHealth and GfK Roper Public Affairs and Corporate Communications on smoking cessation found:
- Virtually all successful former smokers had previously tried to stop smoking an average of 5.4 times before succeeding
- 57 percent of successful former smokers had taken advantage of a smoking cessation program offered by their employer
- 60 percent of those who quit reported that the workplace program was very helpful
Key Motivators for Change.
The good news for employers is that motivation is not lacking. Among current U.S. adult smokers, 70 percent report that they want to quit completely, according to the CDC. The OptumHealth / GfK Roper study sought to understand the triggers that lead to successful behavioral change for smoking and weight loss, and how employers could design wellness programs that respond to those triggers.
Seven out of ten respondents said that living a healthy lifestyle is important to them and believe that their health is mainly determined by their lifestyle choices, not solely by heredity. Clearly, they understand that health is related to behavior. Well over one-half of respondents cited the fear of future health problems as a key driver for changing their behavior. Making a commitment to change was a key factor cited by respondents who smoked. For this group, the secrets for successful quitting included:
- Persistence: Most tried several times to quit before succeeding
- Motivation: Nearly 70 percent said they wanted to improve their health, 65 percent wanted to feel better, and 62 percent wanted to live longer
Other strong motivators among the respondents included the desire to see their children grow up, and the determination to prove that they could quit smoking. Employers should not underestimate the power of these drivers. Their communications with smokers should address that competitive urge and leverage the emotional force of that challenge. Smoking cessation messaging must be inspirational, playing on employees' desire to be healthy and active and to live a long life.
Personal Touch is Key.
Through its research and client experience, OptumHealth has found that robust tobacco cessation programs - those with frequent and intense contacts with wellness coaches - achieve higher quit rates than conventional approaches. These innovative programs are customized to each participant's unique needs and readiness to change. They offer a high level of interaction with a wellness coach throughout the duration of the program, combined with nicotine replacement therapy (gum or patch) to optimize success rates.
The key to a successful cessation program is having a single coach who is dedicated to an employee and with whom close contact is maintained. That intimacy helps build trust and drive results. The coach identifies opportunities for reducing the number of cigarettes smoked and establishes short- and long-term goals against which the smoker is held accountable. These programs are designed to change behavior and pay dividends on the back end.
It starts with multi-method risk identification that uses five separate data streams: online health assessments, on-site biometric screenings, medical insurance claims analysis, employee self-identification and program referrals to identify counseling candidates. Another key component is to stimulate motivation through ongoing communications so that employees will join the program once they are ready. Additional features include detailed monitoring and reporting with specific behavior and lifestyle change metrics.
Paying Dividends.
OptumHealth recently conducted an extensive evaluation of 9,271 employees who enrolled in its most intensive smoking cessation program (which includes multiple methods of identifying candidates, personalized coaching, nicotine therapy and ongoing monitoring). The results were impressive: Nearly 39 percent reported not smoking as of their last call with their coach, and 65 percent of those who completed the program quit smoking.
Additionally, the percentage of participants successfully quitting or reducing smoking increased as the number of coaching calls increased. These programs can also be a smart investment. The combined savings in health care, productivity, workers compensation and disability costs from the program is projected to deliver a targeted return on investment of 1:1 in year one, 2.5:1 in year two, and 4.5:1 in the third year of the program.
While intensive programs like these are designed to work in any corporate culture, they may be best suited for organizations with a high number of smokers - many of whom are willing to make a change, but require more intensive coaching sessions than traditional tobacco cessation programs to help them kick the habit. Without question, quitting smoking is difficult and relapses are frequent. But employers can address this challenge with a vigorous tobacco cessation program that is anchored by frequent, intensive coaching.
About The Author
Beena Thomas, MPH, is Director, Health and Wellness for OptumHealth, a division of United Health Group.
Thomas is a seasoned healthcare professional with over 11 years of experience in innovative product development/implementation, strategic planning and evangelism in total health solutions. Nationally recognized as a subject matter expert in corporate wellness and population health, she has held various roles in the healthcare technology sector and managed care. Thomas spent 10 years at WellPoint/Anthem in sales, human resources and product strategy roles.
As WellPoint's first Wellness Director, Thomas' responsibilities included developing and expanding a national total health management strategy for 42,000 employees across the United States and directing a national women's health strategy. Thomas has assisted national clients in developing strategies and recommending enhancements to their employee health and welfare benefit programs to promote a healthy corporate culture.
Thomas holds a BS in Biology from Georgia State University and an MPH from East Tennessee State University. Thomas completed the American Health Insurance Plans' Executive Leadership Program (ELP) and obtained the ELP certificate from Northwestern University's Kellogg School of Management. Thomas serves on the National Business Group on Health's (NBGH) board for the Institute on the Costs and Health Effects of Obesity and Corporate Health and Wellness Association. She is also a member of Health Enhancement Research Organization's (HERO) Think Tank.
Sources:
1. http://www.surgeongeneral.gov/library/tobaccosmoke/report/executivesummary.pdf
2. http://www.surgeongeneral.gov/library/tobaccosmoke/report/executivesummary.pdf
3. http://www.cdc.gov/tobacco/data_statistics/fact_sheets/cessation/quitting/index.htm.
