Employer Guide: Tobacco Cessation in

the Workplace

The majority of adult smokers say they want to quit, but without help, very few of them succeed…

”“

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Why Tobacco Cessation in the Workplace Matters to Employers .................................................. 3

Establishing a Tobacco-Free Workplace Policy .......................................................... 4

Tobacco Cessation Resources from Health Advocate .................................................. 5

Nicotine Replacement Therapy ................................. 6

Incentive Programs ...................................................... 8

Great American Smokeout (and other Tobacco-Free) Onsite Events ................ 12

Appendix A: Sample Tobacco-Free Workplace Policy ............... 14

Employer Guide: Tobacco Cessation in

the Workplace

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1. U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General.Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014 [accessed 2014 Feb 14].

In the U.S., tobacco use costs billions of dollars each year, including:1

• More than $289 billion a year, including at least $133 billion in direct medical care for adults and more than $156 billion in lost productivity

• $5.6 billion a year (2006 data) in lost productivity from exposure to secondhand smoke

Tobacco cessation continues to be one of the most effective methods to reduce healthcare costs and increase productivity in the workplace. For this reason, more and more organizations are adopting tobacco-free policies, and providing benefits and services to support the prevention and cessation of tobacco use.

Tobacco use not only harms smokers, but secondhand smoke is a serious threat to non-smokers who may be exposed to smoke and toxins in the workplace.

Successful tobacco cessation programs combine multiple approaches to quitting. These include:

• Tobacco-free workplace policies

• Behavior modification health coaching

• Coverage for nicotine replacement therapies (NRT)

• Incentives for quitting tobacco

• Onsite events/campaigns

Actively helping employees quit tobacco will lead to a healthier, more productive workforce and a healthier bottom line. This resource guide contains step-by-step recommendations for implementing successful tobacco-free initiatives in the workplace.

Why Promoting Tobacco Cessation in the Workplace Matters To Employers

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Developing the Policy: Getting Organized

Communication

Establishing a smoke-free workplace policy is an effective way to reduce smoking-related costs and improve the health of employees.

It is strongly recommended that these policies prohibit smoking in all indoor areas of the workplace, as well as all company grounds and vehicles. Permitting tobacco use in designated areas, including separate ventilated areas, is discouraged, because these areas do not always protect employees from harmful secondhand smoke.

There are four main factors to consider when creating a tobacco-free policy:

• What is the purpose of the policy?

• When does the policy go into effect?

• How will the policy be enforced?

• Who is affected by the policy?

There are many strategies for designing an effective smoke-free workplace policy. Some examples include:

• Identify a key management person to coordinate the development and implementation of the policy

• Form a Smoke-Free Committee to assist with the policy’s development. The committee should include representatives from all levels throughout the company, smokers, former smokers, non-smokers and a cross-section of cultural groups

• Determine who in the company must review (e.g., legal) and sign off on the policy and implementation plan

Tobacco-free initiatives should always be framed in a positive light and portrayed as a way to improve the health and well-being of employees.

Communication of the policy to the workforce will determine its success. Messaging around the policy should never attack smokers. Other key points to keep in mind when creating a tobacco-free policy:

• Link the policy to company values and mission

• Provide 3 months of advance notice of the policy

• Promote available tobacco cessation resources and benefits

• Avoid beginning the policy in the winter months

• Work with labor unions (if appropriate)

• Provide incentives to employees for quitting

• Include the policy in your company’s personnel handbook

• Display tobacco-free campus signs at all entrances of the property to notify visitors of the policy

• Determine a contact person for any questions related to the policy

Establishing a Tobacco-Free Workplace Policy

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Tobacco Cessation Resources

Health Advocate offers a variety of resources to help organizations and individuals become—and stay—tobacco-free. They include:

Available at an additional cost to employers, this intensive program gives participants unlimited access to certified Tobacco Cessation Coaches. Our coaches help participants develop personalized quit plans, identify triggers, and provide one-on-one support throughout the entire 12-week program.

Helping individuals access their readiness to quit tobacco (and providing personalized coaching around the benefits of tobacco cessation) is also available as part of Health Advocate’s Wellness Coaching Program.

Included as part of our Wellness Coaching Program, this 8-week, self-directed program helps participants identify their readiness to quit, and, based on their status guides them through the steps to take to become tobacco-free. Participants also have the option to reach out to a coach for added support.

Also included with our Wellness Coaching program, this program offers an array of resources to promote the benefits of quitting tobacco. These resources can be incorporated into onsite events that are centered around tobacco cessation (e.g., The Great American Smokeout), or used throughout the year:

• Campaigns and Promotions. A series of weekly emails contains tips and information about available tobacco cessation resources.

• Posters. A variety of posters are available to promote tobacco cessation and the Great American Smokeout. These resources can be posted throughout your organization.

• Support. Encourage smokers to join a support group. Visit www.nicotine-anonymous.org to find smoking cessation groups in your area.

• Education. Have tobacco cessation tip sheets—and promote available tobacco cessation resources—throughout the year.

Tobacco Cessation Program with Health Coaching

Wellness Coaching Program

Online Tobacco Cessation Program

Commit to Quit Program

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How They Work

The majority of adult smokers say they want to quit, but without help, very few of them succeed over the long term.

Nicotine Replacement Therapies (NRTs) have been proven to significantly increase the chance of quitting smoking and using tobacco. Using NRTs in combination with tobacco cessation health coaching can double the success rate.

Nicotine Replacement Therapies (ex. patches, gum, nasal spray) work by replacing the nicotine one gets from cigarettes with nicotine from the product—without the tar and cancer-causing chemicals.

NRTs gradually reduce nicotine exposure, so that users are able to slowly taper off the number of cigarettes smoked without experiencing any major withdrawal symptoms. There are several types of over-the-counter and prescription NRT options available.

Health Advocate’s Tobacco Cessation Coaches work with participants to determine the most appropriate NRT option(s) on a case-by-case basis.

To maximize your tobacco-free initiatives and support employees in becoming tobacco-free, consider:

• Covering both prescription and over-the counter nicotine replacement therapy and medications

We recommend offering coverage for up to a three month period. Allow at least two smoking cessation attempts per year. Health Advocate can manage your NRT reimbursement program; contact your account manager for more information.

• Eliminating or minimizing co-pays or deductibles for NRT medications — even small co-payments reduce the use of proven treatments

Nicotine Replacement Therapy and Medications

How to Maximize Your Tobacco Cessation Initiatives Using NRTs

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Nicotine Replacement Therapy (NRT)

Other Quit Smoking Medications

Method Availability Description

Nicotine Patches Over-the-Counter The nicotine patch is placed on the skin, and gives users a small and steady amount of nicotine.

Nicotine Gum Over-the-Counter Nicotine gum is chewed to release nicotine. The user chews the gum until it produces a tingling feeling, and then places it between their cheek and gums.

Nicotine Lozenges Over-the-Counter Nicotine lozenges look like hard candy and are placed in the mouth. The nicotine lozenge releases nicotine as it slowly dissolves in the mouth.

Nicotine Inhaler Prescription A nicotine inhaler is a cartridge attached to a mouthpiece. Inhaling through the mouthpiece gives the user a specific amount of nicotine.

Nicotine Nasal Spray Prescription Nicotine nasal spray is a pump bottle containing nicotine, which is put into the nose and sprayed.

Method Availability Description

Bupropion Prescription Bupropion, also known as Zyban®, helps to reduce nicotine withdrawal and the urge to smoke. Bupropion can be used safely with NRT.

Varenicline Prescription Varenicline, also known as Chantix®, helps to reduce nicotine withdrawal and the urge to smoke. It also blocks the effects of nicotine from cigarettes if the user starts smoking again.

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Wellness Programs, Incentives and the PPACA

In addition to implementing a tobacco cessation policy and providing tobacco cessation resources, incentives can further motivate employees to quit using tobacco.

Incentives and the Patient Protection and Affordable Care Act (PPACA)

Increasingly, employers are using incentives tied to outcomes and achievement of health goals.

Today, the most popular incentives are tied to health benefits, usually in the form of a reduction in employee contribution to health coverage based on achievement of specific wellness goals, such as tobacco cessation, or participation in a wellness program.

With the popularity of incentive programs growing, employers must pay close attention to the PPACA’s incentive provisions that took effect on January 1, 2014. These provisions modify regulations that were first introduced as part of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), which stipulated that employer-sponsored group health plans cannot discriminate against group members based on health status. Under the PPACA, an exception has been permitted for wellness programs that offer financial incentives.

Under the PPACA, programs that incentivize employees for both participating AND making measurable changes to their health (i.e. quitting tobacco) are highly regulated and must follow certain rules:

• Employees who are eligible for the program must be given the necessary tools to qualify for the reward, at no cost to them. For example, if you are providing an incentive for employees to quit using tobacco, you must give them free access to a program to help them achieve that goal. The reward must also be offered at least once per year.

• Incentives or rewards are limited to thirty percent (30%) of the entire cost (employer and employee contribution combined) of self-only coverage or, if spouses and children can participate in the program, of family coverage.

• In addition, to the extent that a wellness program targets tobacco use and assigns at least twenty percentage (20%) points of the reward toward that goal, the maximum reward allowable is up to fifty percent (50%) of plan costs.

• Rewards must be made available to all eligible employees, regardless of health status or medical condition.

For more information about incentive programs and their requirements, contact your Health Advocate account manager.

Incentive Programs

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Sample Incentives There are several different types of incentives employers can use to support employees in becoming tobacco-free. It is important to have your legal counsel review your incentive strategy prior to implementation. The most common incentives include:

One-time financial rewards. One-time financial incentives (in cash or gift card form) can be offered to employees for completing the Health Advocate Tobacco Cessation Program. Your account manager can provide instructions on how to obtain the appropriate reports to track program completion.

To complete the telephonic tobacco cessation program, participants must:

• Be tobacco-free for at least one day• Have completed at least six total engagements with a Health Coach.

At least two of the engagements must be made after he/she quits smoking/using tobacco.

For example, if an individual makes six engagements before stopping smoking, he/she must make two additional engagements after quitting to complete the program.

To complete our online tobacco cessation program, participants must:

• Be smoke-free for at least one day• Complete module X of the online program

Financial rewards that get bigger over time. Financial rewards that grow over time have been proven effective for promoting positive and healthy behavior change.

For example, an employer could offer a set amount for completion of a tobacco cessation program, an additional reward for actually quitting tobacco, and an additional incentive for remaining tobacco-free for a specified period of time.

Financial rewards that get bigger over time, but can be taken away all at once in cases of relapse. This approach uses rewards that build on an individual’s fear of losing what they’ve earned, rather than promising something new—a psychological principle called “loss aversion.”

For example, employees can deposit their own money as a stake in the program, with an offer to match their contributions (up to a certain amount) if they achieve their goal. Always give participants the chance to enter the challenge again in the event of a relapse.

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Lottery-style rewards. Instead of offering $3 per day for being smoke-free, give employees a one-in-five chance of winning $10 that day.

This approach is called “variable reinforcement,” and is an effective method of keeping people motivated. Lottery-style payments are unpredictable, entertaining, and a great way to keep employees engaged over time.

Premium differentials. These incentives offer premium differentials based on whether or not an individual uses tobacco.

Small rewards. Giving out small rewards can help establish camaraderie and provide additional motivation to quit for good. Some examples:

• Passes or reimbursement for activities such as dance classes, indoor tennis, gym memberships, etc.

• Gift cards

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Organizations that are committed to creating a tobacco-free workplace and improving employee health can hold onsite Great American Smokeout events. (They can also create tobacco-free awareness events at other times during the year.) Some ideas for your events:

• Utilize elements from the Health Advocate Commit to Quit email campaign and other resources (see page 5) to get the word out about your event.

• If your organization has a Wellness Committee, gather their support. If not, form a special Great American Smokeout Committee.

• Play upbeat music and decorate the room to make it look fun and inviting.

• Hand out Great American Smokeout stickers to everyone who pledges to be tobacco-free or quit smoking.

• Provide branded gift bags with your organization’s logo. The bag could include a flyer, lollipops, a tobacco-free book, healthy recipe cards, and weight management tip sheets.

• At the event, distribute a short survey to find out what tobacco cessation resources your employees are interested in.

Set up Multiple Stations around the Room• Quit Smoking Station. Provide information about tobacco cessation

resources and benefits that are available to employees.

• Bulletin board display. Allow past smokers to share testimonials and stories. Set up a TV station and play tobacco cessation Public Service Announcements (PSAs).

• NRT Table. Provide samples of different types of NRTs and information about the options.

• Blood Pressure/Pulmonary Screening Station. Have a Health Advocate coach available to review screening results and provide tobacco cessation consultation.

• Support a Smoker. Hand out Health Advocate’s tip sheets with information for people who want to support a friend, co-worker or loved one in quitting tobacco.

Contact your Health Advocate account manager if you have any questions, or need additional support promoting tobacco cessation in your workplace.

Great American Smokeout (Or Tobacco-Free) Events

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Purpose

(Company Name) has established a smoke-free policy to comply with (insert reference to state smoke-free law, if applicable), and to protect our employees and visitors from secondhand smoke, an established cause of cancer and respiratory disease. The policy set forth below is effective on [date] for all (Company Name) locations.

Tobacco-Free Areas

All areas of the (Company Name) workplace are smoke-free, without exception. Specifically, smoking is not permitted:

• Anywhere in the workplace, including all indoor facilities and outdoor grounds

• In company vehicles

• In private enclosed offices, conference and meeting rooms, cafeterias, lunchrooms, or employee break rooms/lounges

Tobacco-Free Signage

“No smoking” or “Tobacco-Free Workplace” signs will be clearly posted at all entrances and on bulletin boards, in bathrooms, stairwells and in other prominent areas. Ashtrays are not permitted in any indoor or outdoor areas.

Compliance

Compliance with the smoke-free workplace policy is mandatory for all employees and individuals who are visiting the company, without exception.

Employees who violate this policy are subject to disciplinary action. Any disputes involving this policy should be handled through the company’s established procedures for resolving other work-related problems. If the problem persists, an employee can speak to [company department, name and phone number for complaints] or lodge an anonymous complaint by calling the [insert local government unit’s complaint line or the state’s indoor air unit complaint line or web address, where applicable].

[Company Name] encourages all employees who use tobacco to quit, and offers a variety of resources to employees and dependents to support them in reaching this goal. These resources address specific concerns related to living without tobacco such as how to manage stress, prevent weight gain, and socialize tobacco-free. They include:

• Health Advocate’s Tobacco Cessation Program. A personal Health Coach will support you in quitting tobacco. To speak with a health coach call XXX-XXX-XXXX

• Unlimited access to an online, self-directed smoking cessation program, including tools to measure progress and your preparedness to quit

• Free educational materials about the benefits of quitting tobacco

• Support and encouragement towards achieving a tobacco-free, healthy lifestyle

Questions

Any questions regarding the smoke-free policy should be directed to [company department/ union representative, including phone number(s) for handling inquiries].

Appendix A: Sample Smoke-free Workplace Policy

©2015 Health Advocate HA-B-1408002-2BRO

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