Best Practices: Smoking Cessation Programs
By Adam Gorley
Workers who smoke tobacco can have a significant negative impact on a business’ bottom line, but workplace policies and programs can have a strong positive impact on workers who smoke, according to the Conference Board of Canada. The board’s recent briefing document, “Smoking Cessation Programs in Canadian Workplaces” describes best practices for encouraging workers to quit smoking tobacco, particularly by assessing employees’ general health, targeting smokers, offering a variety of smoking cessation methods and directing smokers toward the appropriate resources.
In April, the Conference Board released the first briefing in its smoking cessation series, focusing on the costs associated with employees who smoke tobacco and the benefits of encouraging them to quit. The board estimates that a business pays $3,400 for every employee that smokes, mainly because employee health issues lead to absenteeism and reduced productivity.
The board finds that many workplaces offer employees help to quit smoking, but numerous factors limit the effectiveness of those offerings. For instance, by offering a generic “one-size-fits-all” smoking cessation program, employers fail to take into consideration the needs of the individual or the specific types of employees that are smoking, trying to quit, and perhaps failing, sometimes repeatedly.
Consider that smoking is more prevalent among certain types of worker than others, and less among others. Nationally, 17.3 per cent of Canadians smoke. Among construction workers, the number is almost twice the national average. Mining, oil and gas extraction, transportation, warehousing, waste management, accommodation and food services, wholesale and retail trade, manufacturing, real estate, agriculture, and a variety of other fields all have averages above 22 per cent. Workers in utilities, information and cultural industries, professional, scientific and technical services, public administration, finance, and education, smoke less than the average. Just understanding the profile of your workforce can help employers target their efforts.
Health Risk Assessments
According to the Conference Board, employers that want to help employees quit smoking would do well to start with a health risk assessment-for all of their employees, not just smokers. Health risk assessments allow employers to evaluate employees’ health risks, and help employees understand those risks as well, “potentially making them more open to changing unhealthy behaviours.” With this information, employers can determine whether they should implement a smoking cessation program, or improve their existing program. Health risk assessments are also the first step toward effective measurement of health programs. The board reports that 49 per cent of the organizations it surveyed offered health risk assessments to some or all employees, and 91 per cent of those assessments considered smoking habits.
The next step is to look at what you can do at the workplace to prevent smoking, for example, implementing a stricter no-smoking policy or taking a more active approach to enforcement. These two steps can make a huge difference in the amount workers smoke (during work hours) and, more importantly, workers’ attitudes toward smoking. Enforcement of a no-smoking policy should also reduce the number of complaints from workers, clients and others that access the workplace, including:
- Improper disposal of cigarette butts
- Second-hand smoke from smoking areas near building entrances
- Smokers who aren’t respecting restrictions related to smoking a set distance from the building
- Smokers who take breaks, in some cases where no formal breaks are allowed
- Air quality and smell in company vehicles after a smoker has used it
- Clients/customers smoking in non-designated areas
The board reports that 80 per cent of organizations surveyed prohibited smoking inside all buildings, but only 19 per cent banned smoking inside and outside. Importantly, 64 per cent of organizations permitted smoking on job sites. Obviously there is a significant opportunity to discourage workers from smoking by prohibiting smoking outside of work buildings and on job sites.
Smoking Cessation Program
Policy is an effective no-cost option to discourage smoking, but to truly help smokers to quit, employers will likely have to offer a smoking cessation program involving medication, counselling and perhaps other therapies. Ideally, according to the board, the program will include both smoking cessation aids and nicotine replacement therapies. Many employers already offer some sort of prescription cessation aids (73 per cent of those surveyed) or counselling via an employee assistance program (78 per cent), but it is crucial that these offerings meet employees’ individual needs. For example, employers sometimes impose lifetime or yearly limits on drug plans. These limits can prevent smokers who are trying to quit from obtaining the medication they need, either during the quitting process or after. In addition, employer health insurance often does not cover nicotine replacement therapies such as patches, gums and inhalers because they are over-the-counter medications.
It’s important to remember that, although most organizations offer some sort of health plan, some plans don’t cover all employees, and other workers have no employer coverage at all. Consider that less than half of employees in the industry with the highest smoking rate (construction) have employer-provided health insurance. The situation for retail workers is even worse: 23 per cent smoke, and only 30 per cent have supplementary health insurance.
A smoking cessation program goes beyond simply including cessation aids and services in an employee’s health insurance package or offering an employee assistance program (EAP). Employers might provide employees with access to self-help resources, or they might provide individual or group counseling at the workplace, as well as smoking cessation aids. One EAP provider offers organizations and their employees two options:
“The first is a personalized program that provides one-on-one coaching by phone with a trained smoking cessation counselor. This is supported by a comprehensive employee handbook based on the principles of cognitive behavioural therapy. The other is an online smoking cessation program that allows employees more flexibility to work independently and at their own pace. It provides access to customized material on smoking cessation, and offers peer support through a moderated online chat forum. Both approaches were developed specifically for the Canadian market and have proven to be effective. Success rates are in the 10-20 per cent range, with higher rates for heavy smokers.”
The Conference Board warns against short-term “Quit to Win” challenges, however, as they may leave former smokers without support in the long term.
Offering a cessation program and aids isn’t enough to help workers who smoke to quit though. Employees must be aware of what is available to them, and understand the benefits. Simply put, “To ensure that their smoking cessation programs are successful, organizations need to actively promote the programs to employees who smoke.” For a program to be effective, employers must use multiple communications channels to inform “hard-to-reach employee segments,” for example, staff meetings, posters, email, payroll messages, benefits booklets, employee newsletters, social networks, the workplace intranet and health and wellness committees. Employees who have successfully used the program can also spread the word.
The final step is to monitor your efforts to assist employees in quitting smoking tobacco. The Conference Board finds that smoking cessation programs “are typically not very costly for employers” The average cost for all employers is $6,265 per year, but the average for organizations with fewer than 500 employees is only $2,735. Employers might not think it necessary or worthwhile to review a program that costs such a relatively little amount, but without evaluating the program’s results, an employer will not only not know whether it is cost-effective, but whether it is effective at helping employees quit smoking.
Among the employers that offered smoking cessation programs, only 20 per cent evaluated the programs, mainly relying on participation rates to gauge success. Others performed surveys or focus groups, gathered informal feedback, reviewed reports from their EAP provider or other benefits/wellness provider, and performed return on investment calculations. Whatever the review method, it is important to follow up with employees to see if they have refrained from smoking or need additional support.
In brief, the Conference Board recommends employers take the following actions to encourage employees to quit smoking:
- Conduct health risk assessments
- Develop a comprehensive non-smoking?policy that includes a smoking ban?on company property
- Cover smoking cessation aids under?your group benefits plan
- Eliminate lifetime maximums for smoking cessation aids and prescription smoking cessation medications
- Combine smoking cessation aids coverage with counseling sessions
- Create effective partnerships with vendors or external suppliers
- Build an integrated wellness plan with a well-designed communications strategy
- Engage senior management in becoming organizational champions for the program
- Monitor and evaluate the program’s success
The board states simply, “Evidence suggests that employers should offer smoking cessation benefits and programs.” It’s easy to understand why, if a single smoker can cost an employer $3,400 (mainly due to absenteeism and reduced productivity) and a smoking cessation for up to 500 employees can cost less than $2,735.
Read the Conference Board briefing here (you’ll need to sign up for a free account).
Adam Gorley is assistant editor at HRinfodesk.com–Canadian Payroll and Employment Law News.
Originally published in HRinfodesk–Canadian Payroll and Employment Law News and Developments July 2013.
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