Tobacco-Use Cessation

Once assessment and planning have been completed, including analysis of the collected data, the next step is implementing the strategies and interventions that will comprise the workplace health program. The intervention descriptions on this page include the public health evidence-baseThe development, implementation, and evaluation of effective programs and policies in public health through application of principles of scientific reasoning, including systematic uses of data and information systems, and appropriate use of behavioral science theory and program planning models. for each intervention, details on designing interventions for tobacco-use cessation, and links to examples and resources.

Before implementing any interventions, the evaluation plan should also be developed. Potential baseline, process, health outcomes, and organizational change measure for these programs are listed under evaluation of tobacco-use cessation programs.

Tobacco use contributes to an extensive list of serious diseases, including cardiovascular and cerebrovascular diseases, multiple cancers, emphysema, and bronchitis; and second-hand smoke contributes to pediatric illness. Tobacco use is responsible for:

• At least $96 billion per year in direct medical costs and¹
• An estimated $96.8 billion per year in lost productivity due to sickness and premature death¹

Tobacco products exist in several forms including cigars, pipes, cigarettes, hookahs (or water pipes), small cigars, bidis (small, thin hand-rolled cigarettes imported to the United States primarily from India and other Southeast Asian countries), chewing tobacco, and snuff. The interventions described in this section focus on smoked forms of tobacco, though several of them could apply to other forms. 

The two major purposes of tobacco cessation programs in the workplace are encouraging tobacco users to quit, and reducing employees exposure to second-hand smoke. Tobacco-free workplace policies and decreasing the numbers of employees who model tobacco-use behavior will also reduce tobacco use initiation among employees and, in addition, may influence tobacco-use behavior in employees families. Nicotine addiction is often severe and may require mulitple quit attempts (8 to 11) before the tobacco user can quit permanently. Health benefits should be structured to provide support for multiple quit attempts.

Top of Page

Tobacco-use cessation programs^2-6

Employee programs refer to activities that include active employee involvement, such as classes or telephone quitlinesTelephone-based tobacco cessation services usually accessed through a toll-free telephone number to provide callers with a number of services such as educational materials, referral to local programs, and individualized telephone counseling including a personalized plan for quitting.. Employee programs are frequently provided on-site at the workplace.

Education and social support programs in the workplace are effective

• One-on-one screening for tobacco use and tobacco cessation counseling with a health provider are effective in helping tobacco users successfully quit
• However, only 50% to 60% of smokers receive advice about quitting smoking from a health care provider, and only 39% of smokers are offered over-the-counter or prescription medication or counseling to support the quitting process
• Health risk appraisals (HRA)An assessment tool used to evaluate an individual’s health. An HRA could include a health survey or questionnaire (see Employee Health Survey); physical examination, or laboratory tests resulting in a profile of individual health risks often with accompanying advice or strategies to reduce the risks. or employee health surveys in the workplace provide assessment and implementation opportunities. However, it is important to recognize that tobacco users do not always self-identify
• Identify the employees who use tobacco, such as through the use of an employee health survey or by screening employees for their tobacco status, and then provide follow-up counseling and treatment. Approaches may include referral to outside organizations or quitlines (state-based or self-contracted) that offer these services or bringing a health educator or tobacco cessation counselor on-site
• Counseling or assistance is usually delivered by trained counselors or health care providers. Use of telephone quitlines can initiate and reinforce a user's efforts to quit. Telephone sessions usually follow a standardized approach to providing advice and counseling, and can be combined with other efforts, such as distributing materials about quitting, formal counseling sessions for an individual or group, or nicotine replacement therapies such as patches or gum

Top of Page

Tobacco-use cessation policies^5,7-8

Workplace policies promote a corporate "culture of good healthThe creation of a working environment where employee health and safety is valued, supported and promoted through workplace health programs, policies, benefits, and environmental supports. Building a Culture of Health involves all levels of the organization and establishes the workplace health program as a routine part of business operations aligned with overall business goals. The results of this culture change include engaged and empowered employees, an impact on health care costs, and improved worker productivity.."

Workplace smoking bans (e.g., smoke-free buildings, campuses, and company-owned vehicles) encourage users to quit and reinforce the company's health emphasis

• Many studies have shown that smoking bans and restrictions are effective strategies to reduce exposure to second-hand smoke, a preventable cause of significant illness and death
• Smoking restrictions that prohibit smoking indoors reduce exposure to second-hand smoke, reduce the number of cigarettes an individual smokes each day, and increase the number of smokers who quit
• In contrast, a tobacco ban would prohibit tobacco use entirely anywhere on the company grounds. Smoking bans are more effective than are smoking restrictions in lowering exposure to second-hand smoke (i.e., environmental tobacco smoke) by an average of 72% in the workplace and in reducing the number of employees who smoke
• Tobacco-free policies should be combined with tobacco cessation campaigns and referral programs. Emphasize that a tobacco-free environment protects everyone—tobacco users and nonusers alike

Top of Page

Health benefits to support tobacco-use cessation^{2-3, 9-10}

Employee health benefits are part of an overall compensation package and affect an employee's willingness to seek preventive services and clinical care.

Full employee benefits for clinical counseling and pharmaceutical treatment will increase employee follow-up on referrals for tobacco use

• Even brief (3 minutes) counseling sessions at each clinical encounter are effective in reducing smoking rates 
• Intensive counseling is even more effective, with individual, group or telephone counseling. Problem solving skills training is an important aspect of intensive or telephone counseling
• Food and Drug Administration-approved medications, whether over-the-counter or prescription (e.g., nicotine patches) have demonstrated effectiveness and should be covered in benefit programs
• All tobacco users may require multiple quit attempts (8 to 11) before they are ultimately successful. Employees with substance misuse or mental health issues will have a particularly hard time quitting
• The evidence is mixed regarding the effectiveness of incentives
• Hypnosis and acupuncture are not effective

Reduce out-of-pocket costs for effective therapies to stop using tobacco

• The Task Force on Community Preventive Services found that programs to reduce out-of-pocket costs are effective in increasing 1) the use of tobacco cessation therapies; 2) the number of people who attempt to quit using tobacco and; 3) the number of people who successfully stop using tobacco
• Strategies include providing services or coverage for or reimbursing the costs associated with tobacco cessation groups, or nicotine replacement or other pharmacologic therapies 
• Nicotine replacement therapies (NRT) include nicotine gum, patches, lozenges, and nasal sprays

Provider reminder systems and provider training improve frequency and quality of clinical treatment

• Health provider contracts should require a clinical reminder system to identify every tobacco user, with patient medical history questionnaires, reminders to providers, and education to providers on successful counseling approaches
• Efforts to increase the number of people who stop using tobacco include prompting health care providers to identify and to discuss with tobacco-using patients the importance of quitting (i.e., provider reminder), an education program for providers, so that they can help their patients quit tobacco use (i.e., provider education), and self-help materials for patients interested in quitting (i.e., patient education)

Free influenza immunizations available at the workplace benefit all employees but especially smokers

• Smokers are at higher risk for respiratory infections and complications and benefit from influenza immunizations

Top of Page

Environmental support for tobacco-use cessation^{7, 11}

Environmental support provides a worksite physically designed to encourage good health.

Creating tobacco-free buildings and campuses requires more than nonsmoking signs

• Integration of multiple approaches such as communications/media campaigns, classes, smoking bans and restrictions, clinical and telephone quitline referrals, benefit coverage, and other activities listed above are more successful in reducing workplace tobacco use than any single program alone

Top of Page