smoking cessation helping employees break the habit · smoking cessation helping employees break...
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SMOKING CESSATION Helping Employees Break the Habit
January 25, 2018
Diane Andrea
Wellness Consultant
J.W. Terrill
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J.W. TERRILL• MARSH & McLENNAN AGENCY LLC
Surgeon General’s Report on Smoking and Health
1964 Report first issued, 42% of Americans smoke
1966 Required warning labels on cigarettes
1969 Begin to phase out cigarette ads on TV and radio
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J.W. TERRILL• MARSH & McLENNAN AGENCY LLC
1970 37% of Americans smoke
1971 Last cigarette ad airs on TV
1975 Army and Navy stop providing cigarette rations to troops
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J.W. TERRILL• MARSH & McLENNAN AGENCY LLC
1980 33% of Americans smoke
1986 Surgeon General Report dedicated to the health effects of
secondhand smoke.
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J.W. TERRILL• MARSH & McLENNAN AGENCY LLC
1990 26% of Americans smoke
1993 The White House goes smoke-free
1999 Outdoor and transit billboard ads for tobacco products
banned
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J.W. TERRILL• MARSH & McLENNAN AGENCY LLC
2000 23% of American’s smoke
2009 Congress authorizes biggest federal tobacco excise tax ever
2014 16.8% of Americans smoke
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J.W. TERRILL• MARSH & McLENNAN AGENCY LLC
50th Anniversary Surgeon General’s Report on Smoking and Health Key Findings
• Cigarette smoking has declined
• Still the leading cause of death and disease
• Secondhand smoke causal factor for stroke
• Increase number of women developing smoking related disease
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J.W. TERRILL• MARSH & McLENNAN AGENCY LLC
“We are at a historic moment in our fight to end the epidemic of tobacco
use that continues to kill more of our citizens than any other preventable
cause.”
Rear Admiral Boris D. Lushniak, M.D.,
Acting U.S. Surgeon General
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J.W. TERRILL• MARSH & McLENNAN AGENCY LLC
Negative Health Effects
• Cancer
– Lung, trachea, esophagus, oral, lip, nasal cavity, larynx, stomach,
bladder, pancreas, kidney, liver, uterine, colon, rectum
• Respiratory disease
– COPD, emphysema, TB, asthma
• Heart disease
– Stroke, cardiovascular disease, PAD, abdominal aortic aneurysm
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J.W. TERRILL• MARSH & McLENNAN AGENCY LLC
Negative Health Effects
• Type 2 Diabetes
• Compromises immune system
• Eye disease
• Reproductive health
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J.W. TERRILL• MARSH & McLENNAN AGENCY LLC
Power of Nicotine Addiction
• Fast acting
• Increases dopamine
• Especially with children and teens
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J.W. TERRILL• MARSH & McLENNAN AGENCY LLC
Current Smokers
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J.W. TERRILL• MARSH & McLENNAN AGENCY LLC
Smokers
$5,800 per year
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J.W. TERRILL• MARSH & McLENNAN AGENCY LLC
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J.W. TERRILL• MARSH & McLENNAN AGENCY LLC
Employer Survey
Believe it is beneficial to provide employees with smoking cessation benefits.
The CDC guidelines would be effective to helping employees quit.
Companies that provide comprehensive smoking cessation benefits
Offer no smoking cessation components.
93%
71%
2%
19%
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J.W. TERRILL• MARSH & McLENNAN AGENCY LLC
Employer Survey
42% 35% 32%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Establishing asmoke-freeworkplace
policy
Coveringcounseling
Coveringprescriptionmedications
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J.W. TERRILL• MARSH & McLENNAN AGENCY LLC
CDC and AHRQ Recommendations
• Cover at least 4 counseling sessions
• Cover smoking cessation prescription medications
• Cover OTC NRT
• Provide counseling and medication coverage for at least 2 smoking
cessation attempts per year
• Eliminate or minimize co-pays or deductibles for counseling and
medications
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J.W. TERRILL• MARSH & McLENNAN AGENCY LLC
Recommendations
• Treat as a chronic disease
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J.W. TERRILL• MARSH & McLENNAN AGENCY LLC
Employer Best Practices
• Smoke-free workplace
• Plan design coverage for medications
• Smoking cessation programs
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J.W. TERRILL• MARSH & McLENNAN AGENCY LLC
Smoke-Free Workplaces
• Smoking restrictions indoors
– Reduces exposure to second-hand smoke
– Reduces number of cigarettes smoked
– Increase in number of smokers who quit
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J.W. TERRILL• MARSH & McLENNAN AGENCY LLC
Smoke-free Workplace
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J.W. TERRILL• MARSH & McLENNAN AGENCY LLC
Workplace Smoking Bans
• Assess the need and interest
– Form committee
– Assess management interest
– Assess the workplace
– Gather input
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J.W. TERRILL• MARSH & McLENNAN AGENCY LLC
Workplace Smoking Bans
• Planning phase
– Convene a planning committee
– Develop a policy
- http://www.cdc.gov/nccdphp/dnpao/hwi/downloads/CDC_tobacco_polic
y.pdf
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J.W. TERRILL• MARSH & McLENNAN AGENCY LLC
Workplace Smoking Bans
• Communication strategy
• Implement the initiative
– Offer cessation resources
– Announce the policy
– Create a supportive environment
– Enforcing the policy
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J.W. TERRILL• MARSH & McLENNAN AGENCY LLC
Workplace Smoking Bans
• Evaluation
– Pre and post implementation surveys
– Smokers who have quit
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J.W. TERRILL• MARSH & McLENNAN AGENCY LLC
The Business of Quitting
• Cover smoking cessation prescription medications
• Cover OTC NRT
• Cover at least 4 counseling sessions
• Provide counseling and medication coverage for at least 2 smoking
cessation attempts per year
• Eliminate or minimize co-pays or deductibles for counseling and
medications
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J.W. TERRILL• MARSH & McLENNAN AGENCY LLC
Effective Medications
• Bupropion SR (Wellbutrin)
• Varenicline (Chantix)
• Nicotine gum
• Nicotine inhaler
• Nicotine lozenge
• Nicotine nasal spray
• Nicotine patch
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J.W. TERRILL• MARSH & McLENNAN AGENCY LLC
Counseling
• Individual, group and telephonic
• Problem solving/skills training
• Social support
• Counseling + Medication = Most Effective
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J.W. TERRILL• MARSH & McLENNAN AGENCY LLC
Resources
• American Lung Association Freedom From Smoking™
– Onsite classes
• American Cancer Society Quit for Life
– Telephonic coaching
• Carrier resources
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J.W. TERRILL• MARSH & McLENNAN AGENCY LLC
Free Resources
• www.smokefree.gov
• www.becomeanex.org
• www.lung.org/stop-smoking/
• www.heart.org
• www.cdc.gov/tobacco/osh
– Tips from former smokers
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J.W. TERRILL• MARSH & McLENNAN AGENCY LLC
Quit Line
• 1-800-QUIT-NOW (1-800-784-8669)
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J.W. TERRILL• MARSH & McLENNAN AGENCY LLC
Complementary and Alternative Quit Methods
• Helpful
– Meditation-based therapies
– Yoga
– Guided imagery
• Not sufficient evidence
– Acupuncture
– Hypnosis
– Dietary supplements
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J.W. TERRILL• MARSH & McLENNAN AGENCY LLC
Examples of Incentives
• Benefit enhancements
• Lower deductibles
• Reduced premiums
• Flexible benefit credits to attend tobacco cessation classes or telephonic
counseling
• Cash
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J.W. TERRILL• MARSH & McLENNAN AGENCY LLC
Benefits Package Options
• Beneficiaries
• Medications
• Counseling
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J.W. TERRILL• MARSH & McLENNAN AGENCY LLC
Tobacco Use Premium Differentials
• Allowable up to 50% of total premium
• Offer as a discount
• Follow ACA guidelines
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J.W. TERRILL• MARSH & McLENNAN AGENCY LLC
ACA Guidelines for Tobacco Use Premium Differentials
• Total reward for a nonsmoker cannot exceed 50% of the total employee-
only coverage.
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J.W. TERRILL• MARSH & McLENNAN AGENCY LLC
• Eligible individuals must be given an opportunity to qualify for the reward at
least once per year.
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J.W. TERRILL• MARSH & McLENNAN AGENCY LLC
• A reasonable alternative standard must be made available to any individual
for whom it is unreasonably difficult due to a medical condition to satisfy the
standard
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J.W. TERRILL• MARSH & McLENNAN AGENCY LLC
• Reasonably designed program, not overly burdensome, not to be a
subterfuge for discriminating bases on a health factor and not be highly
suspect in the method chosen to promote health or prevent disease.
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J.W. TERRILL• MARSH & McLENNAN AGENCY LLC
• The plan must disclose in all plan materials describing the terms of the
program with the availability of other means of qualifying for the reward.
“Stop smoking today! We can help! If you are a smoker, we offer a smoking
cessation program. If you complete the program, you can earn this discount.”
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J.W. TERRILL• MARSH & McLENNAN AGENCY LLC
Key Points to ACA Guidelines
No more than 50% differential
Employer paid program
Employee receives discount regardless if they quit smoking or not
1
2
3
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J.W. TERRILL• MARSH & McLENNAN AGENCY LLC
Verification
• Serum
• Urinalysis
• Saliva
• Affidavit
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J.W. TERRILL• MARSH & McLENNAN AGENCY LLC
Affidavit
I am a smoker or tobacco user and:
I will participate in and complete a company approved smoking cessation program*. Information on company approved programs is available through Human Resources, and you are
responsible for enrolling and completing the program and providing written verification of the
program’s completion to Human Resources by _____________.
*If, due to a medical reason, you are unable to achieve the standard for the tobacco free discount contact
the human resources office to determine requirements for alternative qualification for the discount.
I will not participate in a company approved smoking cessation program and realize I will
not receive the discount.
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J.W. TERRILL• MARSH & McLENNAN AGENCY LLC
Electronic Cigarettes
• Battery-operated device
• Vaporizes nicotine
• Not regulated by FDA
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J.W. TERRILL• MARSH & McLENNAN AGENCY LLC
Electronic Cigarettes
• Can they help?
• Decide
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J.W. TERRILL• MARSH & McLENNAN AGENCY LLC
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J.W. TERRILL• MARSH & McLENNAN AGENCY LLC
Q& A Diane Andrea
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Legal/regional regulatory statement to be added here if required.