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Tobacco-Use Cessation

Once a company has conducted assessment and planning for tobacco-use cessation programs, and developed the specific tasks of implementation for these programs, it is time to develop the evaluation plan. This evaluation plan should be in place before any program implementation has begun.  

Metrics for worker productivity, health care costs, heath outcomes, and organizational change allow measurement of the beginning (baseline), middle (process), and results (outcome) of workplace health programs. It is not necessary to use all these metrics for evaluating programs. Some information may be difficult or costly to collect, or may not fit the operational structure of a company. These lists are only suggested approaches that may be useful in designing an evaluation plan.

These measures are designed for employee group assessment. They are not intended for examining an individual’s progress over time, which would raise concerns of employee confidentiality. For employer purposes, individual-level measures should be collected anonymously and only reported (typically by a third party administrator) in the aggregate, because the company’s major concerns are overall changes in productivity, health care costs, and employee satisfaction.

In general, data from the previous 12 months will provide sufficient baseline information and can be used in establishing the program goals and objectives in the planning phase, and in assessing progress toward goals in the evaluation phase. Ongoing measurements every 6 to 12 months after programs begin are usually appropriate measurement intervals, but measurement timing should be adapted to the expectations of the specific program. 

Tobacco use is the leading cause of preventable illness and death in the United States. Recognized as a cause of multiple cancers, heart disease, stroke, complications of pregnancy, and chronic obstructive pulmonary disease (COPD), tobacco use is responsible for 443,000 deaths per year.1 Tobacco-use cessation improves health by lowering an individual’s risk of developing tobacco-related diseases such as heart disease, stroke, and cancer.

Tobacco use affects productivity and absenteeism, increases use of disability leave, and increases overall health care costs among workers.

  • Tobacco use costs an estimated $96.8 billion per year in lost productivity due to sickness and premature death1
  • Studies have shown that men who smoke use 4 more sick days per year than nonsmoking men, and women who smoke use 2 more sick days per year than nonsmoking women2
  • Of the U.S. adults who smoke, men incur $15,800 and women incur $17,500 more in lifetime medical expenses than men and women who do not smoke (in 2002 dollars)3

The Introduction to Process Evaluation in Tobacco Use Prevention and Control was published in 2008 by the Centers for Disease Control and Prevention (CDC). It applies the standards CDC program evaluation framework (engage stakeholders, describe program, focus evaluation plan, gather credible evidence, justify conclusions and recommendations, and ensure use of recommendations) to tobacco programs. It emphasizes process measures, which determine whether the program is operating efficiently, versus outcome measures, which assess whether the program is having an effect on health.

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Worker productivity measures for tobacco-use cessation4-11

Healthier employees are less likely to call in sick. Companies can sometimes assess sick day use as the most direct measure to determine whether health programs are increasing worker productivity.

Baseline
Process
  • Re-assess the average number of sick days per employee at the first follow-up evaluation
  • Periodic repeats of other baseline measures
Outcome
  • Assess changes in the average number of sick days per employee in repeated follow-up evaluations
  • Assess changes in time employees spend during working hours participating in tobacco use-related worksite programs
  • Assess changes in costs from baseline

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Health care costs measures for tobacco-use cessation4-7,12

In contrast with the worker productivity costs described above, health care costs are measures of the direct medical expenses of providing employee health care and preventive health programs.

Baseline
 
  • Determine current health care use and costs for conditions where individuals have a higher risk associated with tobacco use such as; heart disease and stroke; tobacco-related cancers including lung, lip, oral cavity, pharynx, esophagus, larynx (voice box), pancreas, cervical, bladder, and kidney; and respiratory illnesses (colds, bronchitis, pneumonia, chronic obstructive pulmonary disease)
  • Determine costs and use for health care intended to reduce tobacco use, such as outpatient visits, tobacco cessation counseling services hospitalizations, pharmacologic cessation therapies, and medications for tobacco-use related illness and disability
  • Assess number of employees who utilize tobacco-use treatment services such as counseling or medications (if provided through health benefits)
  • Determine the health care use and costs of current tobacco-use cessation program participants before education and other programs are initiated and after operation of these programs
Process
  • Periodic repeats of baseline measures
Outcome
  • Assess changes in health care use and costs from baseline
  • Assess changes in the number of employees who utilize tobacco-use treatment services (if provided through health benefits)
  • Compare health care use and costs of participants in programs for tobacco cessation before education and other programs are initiated and after operation of these programs
  • Tobacco smoking increases the risk of heart attacks, strokes, lung cancer deaths and other serious health outcomes. However, these are the end stage results of smoking and measurable differences may not be seen for several years. For this reason it is important to measure earlier outcomes such as the number of employees who quit smoking or decreases in sick days

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Health outcomes measures for tobacco-use cessation4-7,12

The effectiveness of tobacco cessation programs depends on the intensity of program effort and the use of multiple interventions. A rule of thumb is that the more programs implemented together as a package or campaign, the more successful the interventions will be.

Baseline
Process
  • Periodic repeats of baseline measures
Outcome
  • Assess changes in employee levels of tobacco use such as:
    • Changes in the number of employees reporting tobacco use or exposure to second hand smoke before and after the tobacco cessation campaign or program
    • Changes in the frequency or duration of employee exposure to second hand smoke
    • Increases in number of employees who remain tobacco free for 6 or more months
    • Increases in the number of quit attempts made by employees
    • Assess changes in the percentage of employees with health conditions, where individuals have a higher risk associated with tobacco use such as heart disease and stroke; tobacco-related cancers including lung, lip, oral cavity, pharynx, esophagus, larynx (voice box), pancreas, cervical, bladder, and kidney; and respiratory illnesses (colds, bronchitis, pneumonia, chronic obstructive pulmonary disease)
    • Assess changes in employee knowledge, attitudes, and beliefs about tobacco use
      • Assess changes in employee awareness of existing workplace tobacco cessation programs, policies, and benefits
      • Assess employee support before and after tobacco policy is implemented (Are employees supportive of how the policy is being enforced?)
      • Number of managers and employees trained on new tobacco cessation programs, policies and benefits

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    Organizational change measures for tobacco-use cessation4-7,12

    Tobacco cessation, along with other health habits, requires ongoing support from employers. New programs can be added over time and evaluated periodically for their effectiveness. For best results, recognition of the benefits of tobacco cessation should become an inherent part of organizational change and corporate culture.

    Measuring organization change is an assessment of company-initiated programs and policies that affect most employees regardless of their health status (e.g., tobacco-free campus policies). These efforts need to be integrated for greatest effectiveness and will require time for full implementation. Regular measures of employee attitudes and program development are key in determining whether new programs are effective or require further adaptation to prevent continuing investment in ineffective efforts.

    Baseline
    • Determine workplace barriers to employee tobacco cessation and to avoidance of second hand smoke at the workplace 
    • Assess current workplace tobacco cessation programs
      • List current tobacco cessation options for employees through worksite and identify number of employees (i.e., participation) using each option. Examples:
        • Number of tobacco cessation programs (e.g., education seminars, individual or group classes) and participation in these programs
        • Availability of educational materials on tobacco cessation
        • Number of communications/media campaigns regarding tobacco use
        • Implementation and enforcement of a tobacco-free campus policy
        • Number of tobacco-use cessation benefit programs (e.g., counseling, medication reimbursement, state-based or self-contracted quitlines) and participation in these programs
        • Development of a training program for managers and employees on new tobacco cessation programs, policies and benefits
        • Number of partnerships with community resources for tobacco cessation such as the American Cancer Society or a local health department
      • Determine costs of current company tobacco cessation programs such as:
        • Staffing, equipment, and space
        • Employee time to participate in tobacco cessation programs during work hours
        • Reimbursements/subsidies for tobacco cessation classes, counseling, or nicotine replacement therapies
        • Incentives tied to tobacco cessation programs
        • Contracts with community quitlines or EAP vendors
        • Maintenance or cleaning costs for buildings and vehicles
      • Conduct survey of employee satisfaction with current workplace supported tobacco cessation options
        • Determine employee support before and after a tobacco policy is implemented (Are employees supportive of how the policy is being enforced?)
      Process
      • Reassess barriers to employee tobacco cessation and to avoidance of second hand smoke at the workplace
      • Document steps taken and progress toward implementing each intervention selected
        • List numeric goals in each form of intervention within a designated time period (e.g., 12 months from startup):
          • Employee reach (e.g., number of educational pamphlets distributed)
          • Employee participation (e.g., number of desired participants in tobacco cessation classes or using state-based or self-contracted quitlines)
        • Describe timeline for implementation of each planned intervention (e.g., length of time and timing of tasks to develop, initiate, and conduct a mass campaign)
        • Create a baseline budget for new interventions including classes, instructors, classroom space, materials, etc
        • Identify opportunities for new partnerships with community groups who provide tobacco cessation programs (e.g., The American Cancer Society, local health department, local hospital, etc.)
      • Reassess employee satisfaction regarding workplace supported tobacco cessation programs
      Outcome
      • Measure reductions in the number and type of employee barriers to tobacco cessation and to avoidance of second hand smoke at the workplace
      • Assess changes in workplace tobacco cessation programs
        • Measure changes in the number of tobacco cessation options for employees through the worksite and changes in employee participation using each option before and after the tobacco cessation program or campaign. Examples:
          • Number of new programs developed and offered to employees and participation in these programs
          • Number of new educational materials developed and made available to employees
          • Number of new workplace communications/media campaigns, including posters, brochures, information on state-based or self-contracted quitlines, employee success stories, organized buddy support systems, etc., established
          • Number of new workplace policies regarding tobacco-free buildings, campus, company-owned vehicles, etc developed, implemented, and enforced compared to baseline 
            • Compliance with tobacco policy (i.e., the number of violations of the policy)
          • Number of new tobacco-use cessation benefit programs (e.g., counseling, medication reimbursement, quitlines)
            • Number of employees identified as tobacco users have been referred for clinical counseling
            • Number of referred employees actually attended at least one clinical counseling session
            • Number of employees prescribed or receiving over-the-counter medications
          • Number of managers and employees trained on new tobacco cessation programs, policies and benefits
          • Number of new partnerships with community groups created to enhance access and opportunity for employees stop using tobacco
        • Assess changes in program costs from baseline
          • Increases in staffing or equipment needs due to new program offerings
          • Changes in employee participation time during work hours
          • Changes in reimbursement/subsidy costs for tobacco cessation classes, counseling, or nicotine replacement therapies
          • New incentives or benefits or changes in existing incentives or benefits based on employee participation
          • New contracts with community quitlines or EAP vendors
          • Changes in maintenance or cleaning costs for buildings and vehicles
        • Assess changes in survey responses for employee satisfaction following implementation of a workplace supported tobacco cessation program and compare with baseline
          • Assess employee support before and after a tobacco policy is implemented (Are employees supportive of how the policy is being enforced?)

      Depending on goal success, evaluate the need to adjust workplace programs.

      Tools and Resources

      Tobacco Use Baseline Measures

      The assessment tools described in the assessment module include specific questions related to tobacco use cessation.

        Health-related Programs

      • Q11; Q12; Q13; Q20a,l,m; Q24a,b,d,e,h; Q26, Q27; Optional Questions A, B, C, E, F, G, I, J, M, JJ, OO

        Health-related Policies

      • Q28d; Optional Questions H

        Health Benefits

      • Q20l; Q32; Q36; Q37; Q38; Optional Question S, T, AA

        Environmental Support

      • Q24g; Q39; Q40; Q41; Q47; Optional Question CC

      Additional Tools

      • CDC Health Scorecard [PDF – 3.5MB] developed by the Centers for Disease Control and Prevention (CDC), the Health Scorecard is a tool designed to help employers assess the extent to which they have implemented evidence-based health promotion interventions or strategies in their worksites to prevent heart disease, stroke, and related conditions such as hypertension, diabetes, and obesity.
      • The National Business Group on Health (NBGH) has developed Tobacco: The Business of Quitting (Key Outcome Indicators For Evaluating Comprehensive Tobacco Control) that leads employers through a step-wise process of building a workplace tobacco cessation program. The site contains a business case, policy and benefits strategies, and employer case studies.
      • Key Outcome Indicators For Evaluating Comprehensive Tobacco Control Programs developed by CDC provides information on 120 key outcome indicators for evaluation of statewide comprehensive tobacco prevention and control programs that could be useful to employers in workplace settings
      • Health Risk Appraisals at the Worksite: Basics for HRA Decision Making [PDF - 2.3MB] is a guide developed by the National Business Coalition on Health in collaboration with the Centers for Disease Control and Prevention (CDC) in the selection and use of health risk appraisals in the workplace available for employers
      • The CDC Healthy Communities Program developed the Community Health Assessment and Group Evaluation (CHANGE) assessment tool to provide communities with a picture of the policy, systems, and environmental change strategies currently in place throughout the community, where gaps exists and facilitate action planning for making improvements. The CHANGE tool address five community sectors including worksites and health indicators related to physical activity, nutrition, tobacco use, chronic disease management, and leadership

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