Tobacco Cessation Services Provided by Worksites
Some employers provide employees with access to tobacco cessation counseling or education classes in the workplace. This model can be especially important for rural workers who may lack time or transportation options to access these resources outside of the workplace.
Many employers include this cessation treatment as part of a larger workplace wellness program. Workplace wellness programs are offered by employers to their employees to promote positive health habits. Programs may provide incentives to attend no-cost health education seminars or reimburse employees for fitness center memberships. Some employers may also support employees' attempts to quit using tobacco by providing coverage for evidence-based tobacco treatments or reducing the out-of-pocket costs for these services.
There are many advantages to providing employees with tobacco cessation services. The Centers for Disease Control and Prevention (CDC) reports that employers break even when implementing a tobacco cessation program within three years and begin saving money within five years. In addition, employees who quit smoking can reduce costs associated with cardiovascular disease and other smoking-related conditions. Workers who use tobacco products may also be less productive than those who do not. America's Health Insurance Plans provides a return on investment calculator for covering and promoting smoking cessation.
The CDC, the Agency for Healthcare Research and Quality (AHRQ), and the National Business Group on Health prepared A Purchaser's Guide to Clinical Preventive Services: Moving Science into Coverage. The Guide informs employers that are designing health benefits about recommended clinical preventive services. For employers seeking to support employees' tobacco cessation efforts, the guide recommends the following evidence-based guidelines:
- Promoting smoke-free (or tobacco-free) worksites.
- Increasing access to several counseling options (such as individual and group) and FDA-approved tobacco cessation medications by providing coverage or reducing copays for these services.
- Informing employees if nicotine replacement therapy is an eligible expense under their flexible spending account (FSA).
- Promoting state tobacco quitlines among employees or contracting with quitline vendors. Some state quitlines have Preferred Employer Programs that provide free education materials for employees or offer individual contracts to businesses that allow employers to track employees' progress.
Incentives and Competitions to Increase Smoking Cessation among Workers
In this model, worksites sponsor competitions for employees that promote smoking cessation, or provide incentives for abstaining from tobacco use. A competition could involve a contest that rewards a worker who abstains from tobacco for the greatest number of days abstinent. Incentives, such as a monetary reward, may be provided. While the Community Guide recommends incentives and competitions to increase smoking cessation among workers, this model is only effective when combined with other evidence-based interventions, including cessation groups, education, self-help materials, telephone support, smoke-free policies, and social support networks. This model is effective in urban and suburban settings, but has not been rigorously evaluated in rural communities.
Examples of Tobacco Cessation Programs Provided by Rural Worksites
- The West Florida Area Health Education Center—which serves rural populations in Escambia, Okaloosa, Santa Rosa, and Walton Counties—offers to hold tobacco cessation classes at local businesses. Employers can select either a one-time education session, Tools to Quit, or a comprehensive tobacco cessation program, Quit Smoking Now. All classes are led by a Certified Tobacco Treatment Specialist and program participants receive free Nicotine Replacement Therapy to support their efforts to quit.
- Union Pacific Railroad (UPRR) has offered tobacco cessation benefits to its employees, many of whom live in rural areas, since 1990. UPRR has provided a range of educational services that include information about smoking behavior such as Know Your Health Numbers trainings and peer support programs. In addition, the company offers cessation services that include access to telephone, in-person, and internet counseling, as well as coverage for tobacco cessation medication.
- In 2005, three businesses in rural Wisconsin implemented a worksite wellness initiative called the proACTIVE Wellness Initiative. At one worksite, six of 53 participating employees quit smoking during the nine week program. The program's creator, Black River Memorial Hospital, now offers a menu of occupational health and wellbeing services that local business can use to build their own tailored worksite wellness program. These services include tobacco education and cessation.
Considerations for Implementation
The Tobacco Control Legal Consortium fact sheet, Legal Considerations in Implementing a Tobacco Cessation Program in the Workplace, suggests that employers seeking to establish a tobacco cessation program should first consult with a legal professional to discuss liabilities and legal implications. In particular, employers may need to familiarize themselves with HIPAA nondiscrimination regulations and “smoker protection laws” when designing tobacco cessation programs. This is particularly important for employers seeking to implement policies that increase health insurance premiums (in other words, impose penalties) for employees who smoke.
Program Clearinghouse Examples
Resources to Learn More
to Quit Worksite Toolkit: Strategies for Creating a Healthier Work Force and Bottom Line
This toolkit aims to provide employers with strategies to adopt tobacco-related insurance benefits in order to help their employees quit tobacco use.
Organization(s): Tobacco Free Florida, Florida Department of Health
Employer Guide to Tobacco
This toolkit examines the healthcare costs related to smoking, shows advantages of having a smoke-free workplace, provides information on the legal issues involved, and gives suggestions for helping employees quit smoking.
Organization(s): WorkSHIFTS, Public Health Law Center
This fact sheet describes a program that offers information, strategies for coping with tobacco cravings, and support through group meetings. An employer must designate a representative to complete a training, after which the employer receives access to the program materials and can begin offering Freshstart® at the worksite.
Organization(s): American Cancer Society
for the Development of Effective Agency Tobacco Cessation Programs
This guide provides recommendations to government agencies that are developing tobacco cessation programs for employees.
Organization(s): Office of Personnel Management
the Affordable Care Act Affects Tobacco Use and Control
This fact sheet lists and explains the main sections of the Affordable Care Act (ACA) that relate to insurance coverage for tobacco cessation programs.
Organization(s): Tobacco Control Legal Consortium
This Cochrane Review examines the impact of incentives and contingency management programs on long-term quit rates.
Author(s): Cahill, K., Hartmann-Boyce, J., & Perera, R.
Citation: Cochrane Library
Quit and Win
Contests for Smoking Cessation
This Cochrane Review examines whether quit and win contests contribute to higher long-term quit rates than baseline community quit rates.
Author(s): Cahill, K. & Perera, R.
Citation: Cochrane Library
Health Strategies: Tobacco-Use
The CDC provides information and compiled resources for employers seeking to implement tobacco cessation programs and policies.
Organization(s): Centers for Disease Control and Prevention
Interventions for Smoking Cessation
This Cochrane Review examines the outcomes of controlled studies for workplace smoking cessation interventions.
Author(s): Cahill, K. & Lancaster, T.
Citation: Cochrane Library