National Business Group On Health

A Purchaser's Guide is available at www.businessgrouphealth.org

Employers ranked smoking--the leading preventable cause of disease and premature death in the U.S.(1)--among their top three employee health priorities along with high blood pressure and obesity, according to a new survey released by the National Business Group on Health.(2) Furthermore, eighty-two percent of employers said that they should take steps to help employees quit smoking.(2) Most employers said that they believe that establishing smoke-free workplaces is the best way to encourage smokers to quit, but the survey found that employees who smoke most wish that employers would offer access to smoking cessation benefits to help them quit.(2)

Many employers have begun to place value on eliminating smoking from the workplace to decrease secondhand smoke and also motivate smokers to quit.(2) However, more than three-quarters (78 percent) of employees surveyed who work at companies with smoke-free workplaces say the policy is not effective in motivating them to quit.(2) This key difference between employer and employee perceptions on the effectiveness of current smoking cessation efforts in the workplace has important implications for the policies employers adopt to help their employees quit smoking.

"While employers recognize the value of a smoke-free workplace, many may not know about the benefits of a systematic approach to smoking cessation," said Ron Finch, vice president at the Business Group. "Benefit managers and health care practitioners treat smoking as an acute problem, instead of the chronic condition that it is. We need to change this perception. In this survey we heard from smokers that they want support through comprehensive smoking cessation benefits."

The survey of 508 employers and 510 employees who smoke explored employers' and employees' understanding, beliefs and actions about tobacco use, nicotine addiction, and smoking cessation practices.(2) Preliminary results of the survey were presented at the recent National Business Group on Health/Integrated Benefits Institute Joint Forum on Health, Productivity & Absence Management in Washington, D.C. during a breakout session led by
speakers from private and public sectors including the Business Group, the Centers for Disease Control and Prevention (CDC) and Partnership for Prevention.

Overall, smoking poses a significant medical and economic burden to society and has an extensive impact on employers' bottom lines. In 1999, excess medical expenses due to smoking and smoking-related illnesses cost employers $1,850 per smoking employee; lost productivity due to smoking and smoking-related illnesses cost employers $1,897 per smoking employee.(3)

"While we all intuitively know that smokers taking cigarette breaks cuts into their productivity at work, we learned from this survey that the extent of time lost at work due to smoke breaks could be staggering," said Ron Finch.

Nearly 50 percent of smokers self-reported taking between three and six smoking breaks per day, and more than two-thirds of those who take smoke breaks said they last between five and fifteen minutes.(2)

Furthermore, nicotine addiction from smoking is a chronic, relapsing medical condition that is often difficult to overcome.(4) It often takes smokers several attempts before they successfully quit. The survey showed that approximately 50 percent of employees surveyed reported having made between three and 10 quit attempts.(2) However, literature has shown that a combination of medication and behavior modification can increase successful quit rates.(5) The survey showed that both employers and employees consider smoking to be a treatable condition.(2)

"These survey results illustrate to employers and benefit managers the need to develop a comprehensive smoking cessation benefit plan," said Ron Finch. "The critical employer decision is creating a program that supports employees' ability to successfully quit for good."

    Practical Guidance for Action

    Both the CDC and Partnership for Prevention have reported that providing smoking cessation benefits is the number one cost-effective benefit employers can provide, along with aspirin therapy and childhood immunizations, yet it is often underutilized.(6) According to Partnership for Prevention, currently fewer than 24 percent of employers offer comprehensive smoking cessation programs.(6)

    "It's unclear why there's been such limited support for smoking cessation benefits to date," said Finch. "It could be that employers are not aware of the need to treat smoking like other chronic medical conditions, or don't understand how to provide the benefit since it often
is not offered as part of standard medical benefits."

    To provide employers with a practical, step-by step tool for assessing and implementing the best preventive health benefits -- including smoking cessation -- the Business Group last week released the Purchaser's Guide, produced with input from the Agency for Healthcare Research and Quality (AHRQ) and the CDC. Copies of the Purchaser's Guide are available at
http://www.businessgrouphealth.org.

    Additionally, the CDC recommends that all insurers provide tobacco cessation benefits that provide coverage for the following(6):
    -- Four to six counseling sessions of at least 30 minutes each
    -- Both prescription and over-the-counter medications
    -- At least two quit attempts each year; as well as
    -- Limited or no co-payments

    About the Survey
    The online survey, which was conducted by StrategyOne, an applied research consulting firm, and fielded by Harris Interactive Service Bureau, polled two audiences: employers and employees. The employer component included 508 benefits decision-influencers from companies with 500 or more employees that offer health benefits. The employee component included 510 full-time employed smokers who work for companies with 500 or more employees that offer health benefits. Both surveys have a margin of error of plus or minus 4.3 at the 95% level of confidence. This educational initiative was sponsored by Pfizer Inc.

    About the National Business Group on Health
    The National Business Group on Health, representing more than 240 large employers, is the nation's only nonprofit organization devoted exclusively to finding innovative and forward-thinking solutions to large employers' most important health care and related benefit issues. The Business Group identifies and shares best practices in health benefits, disability, health
and productivity, related paid time off and work/life balance issues. Business Group members, primarily FORTUNE 500 and large public sector employers, provide health coverage for more than 55 million U.S. workers, retirees and their families.

    REFERENCES:
    (1) U.S. Department of Health and Human Services. The Health Consequences
        of Smoking: A Report of the Surgeon General. 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, 2004. Introduction and approach to
        casual inference. Available at:
        http://www.cdc.gov/tobacco/sgr/sgr_2004/pdf/chapter1.pdf. Accessed
        April 13, 2006.
    (2) Smokers in the Workplace Study: A survey of employers and employees.
        National Business Group on Health (2006).
    (3) Centers for Disease Control and Prevention. Annual smoking-
        attributable mortality, years of potential life lost, and economic
        costs - United States, 1995-1999. Morbidity and Mortality Weekly
        Report 2002;51(14);300-03.American Cancer Society.
    (4) Commonwealth of Massachusetts Department of Public Health. Tobacco
        Guidelines 2004. Available at:
        http://mass.gov/dph/bsas/funding/tobacco/guidelines.htm.  Accessed
        December 5, 2006.
    (5) National Institute on Drug Abuse. Research Report Series: Tobacco
        Addiction. Rockville, MD: U.S. Department of Health and Human Services
        National Institutes of Health; 2006. NIH Publication No. 01-4342.
        Available at:
        http://www.nida.nih.gov/ResearchReports/Nicotine/Nicotine.html.
        Accessed October 16, 2006.
    (6) Centers for Disease Control and Prevention. Coverage for Tobacco Use
        Cessation Treatments. Available at:
http://www.cdc.gov/TOBACCO/educational_materials/cessation/ReimbursementBrochureFull.pdf.
    Accessed October 30, 2006