Tobacco Cessation at Workplaces Dr. Rakesh Gupta Consultant (India) Cancer Control Strategies- Workplace American Cancer Society

Agenda Background information- why tobacco users do not (cannot) quit but why workplaces should provide tobacco cessation ACS India Workplace Solution for being smoke-free/ tobacco-free ACS offerings for tobacco cessation Corporate Workshop New Delhi. 10 Feb. 09

The basis for tobacco use Why people get ‘hooked’ to it? The journey: Adventure to addiction- The triggers: physical and psychological (person, place and time) Corporate Workshop New Delhi. 10 Feb. 09

Inability to quit The Evidence- High relapse rate The social reason- a nuance vs. disease; Ignorance and indifference of health professionals Lack of resources within the health system and workplaces Corporate Workshop New Delhi. 10 Feb. 09

Evidence of Potential for Quitting US Statistics Former smokers vs. current smokers; 47 million vs. 43 million Annual cancer incidence and mortality Incidence- decreased by 0.8% (1990- 2005); and, Mortality- decreased by1.8% (2002-05) "The most significant thing to talk about now is for people to stop smoking," he said. “There's nothing that comes close to it in terms of direct impact on cancer rates." Dr. Len Lichtenfield, Dy. CMO, NHO, ACS Corporate Workshop New Delhi. 10 Feb. 09

The economic basis for recommending tobacco cessation Quitting benefits:1. Short term; 2. Long term The economic basis for recommending tobacco cessation Health care expenses: A smoker costs 18% more than a non-smoker1 Workplace productivity loss: +2.5 week days per year- more breaks and less productive2 Cost/s to an Individual if he does not quit (Rs.30 x 30x 12= Rs. 10,800); a case for salary deduction 1. Pronk Np, Goodman MJ, O’Connor PJ, et al. Relationship between modifiable behavioral risks and short-term health care charges. JAMA. 1999;282:2235-39. 2. Hapren MT, Shikiar R, Rentz AM, et al. Impact of smoking status on workplace absenteeism and productivity. Tobacco Control. 2001;10:233-38. Corporate Workshop New Delhi. 10 Feb. 09

The case for promoting wellness (tobacco control) in workplaces Workplace: A powerful setting for at-risk young employees The choice Curative Healthcare- Incompleteness of Technology for Cure Preventive Healthcare- Preventing Disease Completely The Industry standard for ROI- 3.15 times A good case for business Why promote health in workplaces? The workplace is a powerful setting to large numbers of at-risk adults with effective chronic disease prevention programs. The basis is to choose between curative health care with “incompleteness of technology for cure” vs. preventive health care “preventing illnesses completely”. Also, it makes sense to do in younger age group since it lowers depreciation on health capital vs. older age wherein a higher depreciation demands a simultaneous higher investment on curative care. AGE Investment at younger age has lower depreciation on Health Capital vs. older age- a higher depreciation and higher cost of cure ROI A well- designed Workplace Wellness Program can reduce 25% of the health care cost, sick-leave, disability pay and worker’s compensation (Dallas Chamber Report, 2006) P C E Corporate Workshop New Delhi. 10 Feb. 09

ACS approach to Comprehensive Employee Health & Wellness To achieve Employee Health and Wellness comprehensively, American Cancer Society recommends a four fold approach. It is to focus on: Health benefits, the insurance in particular, as it affects the workers’ use of tobacco; Policy which reduces or eliminates harmful risk factors such as second-hand smoke; and, encourages an access to a healthier behavior (avoiding/ quitting tobacco); Employee Programs which offer them an easy access to and social support for eliminating tobacco use; and, Health Communication to improve their knowledge and shape beliefs, attitude and perceived norms about tobacco use and benefits of quitting. (Ref. Harris et al (2009). Workplace Health Promotion in Washington State. Preventing Chronic Disease. Vol.6, No.1. Pages 1-10. January 2009. Corporate Workshop New Delhi. 10 Feb. 09 8

Evidence Based Strategies: Tobacco-free Workplace Targeted Employee Behavior Benefits3 Policy1 Employee Programs2 Commun-ication1a Tracking1b Reduce / eliminate tobacco use among employees Provide full coverage for tobacco cessation treatments: 1. prescription medications, 2. over-the-counter nicotine replacement therapy, and 3. Counseling Ban tobacco use at worksites Sponsor a tobacco cessation program including Quitline; sponsor nicotine replacement therapy Conduct targeted health promotion campaign focusing on key health behaviors Survey employees’ health behaviors to track effectiveness of health promotion effort Corporate Workshop New Delhi. 10 Feb. 09

The ACS India Workplace Solutions: Tobacco Cessation Quitline- the telephone based counseling Freshstart- the on-site program Others: Tobacco Cessation Clinics Project- MOH & WHO Pharma coordinated network of cessation clinics Cessation Clinics under National Tobacco Control Program Web resources and Online/ onsite counselors Corporate Workshop New Delhi. 10 Feb. 09

Launched in India in December 08; Tuesday- Saturday; 12-10PM India Workplace Solution Products: Tobacco Cessation- Telephone Counseling Quitline Allows an individual quit at his convenience and with confidentiality Does not involve workplace collaterals and employee engagement Countrywide reach Provides an Introductory plus 5 counseling sessions and three evaluations; additional help A high quit rate of 49% at six months The next four slides describe our signature offerings to the Indian workplaces. Quitline is our telephone counseling to quit tobacco. It was launched in December 2008 and operates from its base in Delhi. The Society already has partnership with a multinational IT organization for its six workplaces countrywide for an employee strength over 12,000. Quitline: (1) Allows an individual quit at his convenience and with confidentiality (2) Does not involve workplace collaterals and employee engagement (3) Has a Countrywide Reach (4) Provides an Intake plus 5 counseling sessions along with self-help books at cost; the three evaluations at 3, 6 and 12 months of quitting and any additional help sought throughout the period of our contract through a schedule have no cost. (5) Has a high quit rate of 49% at six months. Launched in India in December 08; Tuesday- Saturday; 12-10PM Corporate Workshop New Delhi. 10 Feb. 09 11

India Workplace Solution Products: Tobacco Cessation Onsite Freshstart - four one-hour sessions of tobacco cessation counseling program are held during a two-week period Features Designed for adult tobacco users Convenient for most people’s schedules, even in the workplace Uses group interaction to support an individual quit Addresses variety of reasons why people use tobacco Goals- Creating readiness and environment to support quitting tobacco Advantages Makes maximum use of the tobacco user’s time Helps participants to set-up the QUIT DATE earlier in the program Freshstart is an on-site tobacco cessation program delivered through four one hour sessions tobacco cessation counseling program held during a two-week period. Its Features include: (1) Its Design meant for adult tobacco users (2) Utilization of group interaction to support quitting goals (3) Address to the variety of reasons why people use tobacco Its Advantages are: (1) Helps setting the Quit date “early” in the program (2) Makes maximum use of the tobacco user’s time- it is convenient for most people’s schedules, even in the workplace “Creating readiness and environment to support quitting tobacco are main goals.” The Society has experienced its benefit as it assisted the State Police Academy in Rajasthan- the training place for a workforce over 80,000- become tobacco-free. Sets in climate for becoming tobacco-free Corporate Workshop New Delhi. 10 Feb. 09 12

Conclusion Quitting benefits: The best way to limit harm due to tobacco is to quit now. "Most of it is reversible, particularly if you can stop early on “1 Quitting is “doable” and it is “good economics” Tobacco cessation can succeed if workplaces provide it “free” to the employees 1. Tom Glynn, American Cancer Society. Personal Communication, 2009 Corporate Workshop New Delhi. 10 Feb. 09

Thanks Questions? Reference- www.cancer.org Contact- ACSindiainitiative@cancer.org; rakesh.gupta.acs@gmail.com Call- +91-93516 24313 I thank you all for your attention. Corporate Workshop New Delhi. 10 Feb. 09