1. A Comprehensive Approach to Smoking Cessation in the Workplace Start Living Healthier

3. Smoking and Human Health Smoking – An Addiction to Nicotine Smoking & Productivity Why Should Employers Help Employees Stop Smoking? What Supports Can Employers Provide and What Supports are Ideal? Start Living Healthier

4. Background & Rationale Start Living Healthier

5. Background & Rationale Cessation therapy and counselling is the most cost effective health intervention that an employer can provide. Data on the impact of smoking on workplace health and productivity was limited. Nicotine therapies were initially seen as magic bullets to smoking cessation. Access and evidence to support cessation counselling were not available. The effect of smoking on workplace health and productivity is currently well documented. Start Living Healthier

6. Smoking and Human Health Start Living Healthier

7. Smoking and Human Health “Canada has no choice but to adopt a new model of health care, a business model that encompasses both preventing and managing chronic disease.” (Conference Board of Canada) Smoking is a major contributor to several chronic diseases:  Cardiovascular disease, including stroke, heart attack, etc.  Cancer  Emphysema/chronic obstructive pulmonary disease  Diabetes Smoking affects every system in the body ‘Smoke goes where blood flows!’ Start Living Healthier

8. Smoking and Human Health Tobacco Users are:  Six and a half times more likely to die from lung cancer than non-smokers  At double the risk for a stroke  At three times the risk to die from heart attack, than non-smokers In Canada, smoking accounts for a large percentage of deaths:  87% of lung cancer deaths – lung cancer is the leading cause of cancer deaths for both Canadian men and women  30% of all cancer deaths  21% of all coronary heart disease deaths  10% of all infant deaths Start Living Healthier

9. Smoking and Human Health Tobacco is the only legally available consumer product which kills people when used entirely as intended. World Health Organization Start Living Healthier

10. Smoking – An Addiction to Nicotine Start Living Healthier

11. Nicotine Withdrawal 8:00 am - Had a cigarette 10:00 am - Experiencing withdrawal 12:00 pm - Reaching peak withdrawal Start Living Healthier

12. PHYSICAL BEHAVIOURAL EMOTIONALPSYCHOLOGICAL

13. Smoking Cessation… Myths and Misconceptions “Most smokers do not want to stop smoking”  FALSE! 91% of people who smoke have at least some desire to quit smoking and over half are seriously considering quitting within the next 6 months “You just need willpower to stop smoking”  FALSE! Nicotine addiction is a complex addiction (a chronic relapsing condition). Supports, such as counselling and medication, are effective tools to help stop smoking Start Living Healthier

14. Smoking Cessation… Myths and Misconceptions “Stopping smoking is a one time event”  FALSE! It takes an average of 4-5 attempts to stop completely. Each stop attempt has proven health benefits “If you relapse, you’ve failed at your attempt to stop smoking”  FALSE! Stopping smoking is a process, not an event. Each ‘attempt’ should be considered a success and the employer should never stop supporting the process Start Living Healthier

15. Smoking Cessation… Myths and Misconceptions “Smoking cessation only benefits the smoker”  FALSE! Non-smokers who work in smoke filled/exposed environments inhale the same 4000 toxic and carcinogenic chemicals as smokers. Cigarettes produce 12 minutes of smoke, and the smoker inhales only 30 seconds of smoke. The rest lingers in the air – and affects all who are exposed Start Living Healthier

16. Impact on the Workplace: Smoking & Productivity Start Living Healthier

17. Time Off Work Decreased Productivity What’s the Impact on the Workplace? Employees smoking costs employers money! Higher Insurance Costs Employee Smoking Start Living Healthier

18. What Does This Mean for Your Company? The Burden of Smoking Enter number here (double click) Start Living Healthier

19. What Does This Mean for Your Company? Return on Investment Calculation based on the assumption that counselling can be obtained free of charge from the Smokers Helpline as well as one-on-one or group counselling offered through occupational health and safety and/or local health authorities. Enter number here (double click) Start Living Healthier

20. Smoking & the Workplace … Totalling the Costs in Atlantic Canada Annual Cost to Employers in Nova Scotia Increased absenteeism$ 22.0 Million On-the-job productivity losses$ 208.0 Million Increased life insurance premiums$ 9.0 Million Smoking area costs$ 10.0 Million TOTAL$ 249.0 Million Start Living Healthier

21. Smoking & the Workplace … Totalling the Costs in Atlantic Canada Annual Cost to Employers in New Brunswick Increased absenteeism$ 18.2 Million On-the-job productivity losses$ 174.9 Million Increased life insurance premiums$ 7.2 Million Smoking area costs$ 8.0 Million TOTAL$ 208.3 Million Start Living Healthier

22. Smoking & the Workplace … Totalling the Costs in Atlantic Canada Annual Cost to Employers in Newfoundland Increased absenteeism$ 11.9 Million On-the-job productivity losses$ 94.8 Million Increased life insurance premiums$ 4.5 Million Smoking area costs$ 5.1 Million TOTAL$ 116.3 Million Start Living Healthier

23. Smoking & the Workplace … Totalling the Costs in Atlantic Canada Annual Cost to Employers in Prince Edward Island Increased absenteeismN/A On-the-job productivity losses$ 43.0 Million Increased life insurance premiumsN/A Smoking area costsN/A TOTALN/A Start Living Healthier

24. Smoking & the Workplace … Totalling the Costs (annually) $3,053 Smoking Breaks Time Off Due to Illness $323 Life Insurance $84 Health Insurance $75 Smoking Area $20 TOTAL = $3,555 per Smoking Employee Equal to an Average of 8.7% of Payroll Start Living Healthier

25. Smoking: Why Should Employers Help Employees Stop Smoking? Start Living Healthier

26. Blood pressure & pulse return to normal Oxygen levels return to normal Risk of heart attack begin to decrease Sense of taste & smell improve 20 Minutes 8 Hours 24 Hours 48 Hours Start Living Healthier

27. Improvements in lung function and circulation Risk of heart disease is reduced by 1/2 Risk of lung cancer is reduced by 1/2 Lungs improve capacity to clear & reduce infection Risk of stroke is reduced Risk of heart disease is similar to a person who never smoked 2 Weeks 9 Months 1 Year 5 Years 10 Years 15 Years Start Living Healthier

28. Why Help? Improve employee health  Smoking is the single most preventable cause of disease and death  Second-hand smoke is a health risk to non-smoking employees Stop smoking programs are the single most effective and cost efficient support employers can provide to improve employee health Start Living Healthier

29. What Supports Can Employers Provide - What is Ideal? Start Living Healthier

30. Range of Smoking Cessation Programs/Supports Comprehensive (greatest impact!)  Offering programs, supports and activities at the workplace (on-site, during work hours, etc.) Facilitated  Working with outside agencies to deliver programs, supports and activities off-site and providing self-help materials Education & Information  Provision of educational self-help materials Start Living Healthier

31. Success Only 2.5-5% of smokers who attempt to quit unaided will succeed Without support, smoking cessation is challenging for employees. Start Living Healthier

32. Success Medication and intense face-to-face counselling increases success The provision of workplace support will empower employees to work towards reaching their cessation goals. Telephone counselling + medication increases success Start Living Healthier Compared to no support, face-to-face counselling increases success Telephone counselling + one session face-to-face counselling increases success Smoking cessation medication triples long-term success NRT doubles long-term success

33. Supporting Smoking Cessation Smokers are 2-3 times more likely to succeed with support than without Stop smoking rates increase when a workplace smoke free policy (restriction) is implemented  Over 26% of the smokers who were prohibited from smoking at work had stopped smoking in the past 6 months, compared to 19% without a no smoking policy Start Living Healthier

34. A Comprehensive Approach Considerations There should be no cost to the employee to participate, and medications/nicotine replacement therapy should be subsidized Cost Start Living Healthier

35. A Comprehensive Approach Considerations Program should be accessible:  Offered on-site /made available across multiple sites  Offered during work hours (not in lieu of normal breaks)  Provide a range of supports - Smokers Helpline, one-on-one counselling, group counselling, etc. Accessibility Start Living Healthier

36. A Comprehensive Approach Considerations Smokers Helpline – free, confidential telephone support, tips, tools and advice from trained ‘Quit Specialists’  NS, NB, PEI - 1-877-513-5333 www.smokershelpline.ca  NL - 1-800-363-5864 www.smokershelp.net Accessibility Start Living Healthier

37. A Comprehensive Approach Considerations The provision of cessation supports should align with what your company can feasibly support (within its capacity) Consider: How many employees smoke; employee interest in stopping smoking; how employees prefer to engage in cessation; employee expectations around workplace stop smoking supports; gauge employee interest in using the types of supports the employer plans to offer Tailoring Start Living Healthier

38. Program Success: Representation & Engagement of Key Stakeholders Engage stakeholders at all stages Provide a voice to all workplace parties Supported by management, but not management driven  A committee could be formed to represent management, employees, etc. Start Living Healthier

39. Program Success: Promotion The program needs to be effectively promoted to generate interest & encourage participation among employees Employees should have the opportunity to provide feedback on program success and potential areas for improvement Start Living Healthier

40. Thank You Start Living Healthier Thank you to CDHA for their participation in content development.

41. References 1.Canadian Cancer Society (2008). Effective Workplace Tobacco Cessation Interventions 2.Canadian Cancer Society (2008). Second Hand Smoke is Dangerous. 3.Canadian Cancer Society (2008). Tobacco Statistics in Canada; 4.Canadian Lung Association. Making Quit Happen. 5.Conference Board of Canada (2008). How Canada Performs: A Report Card on Canada Health Overview 6.Conference Board of Canada (2006). Smoking and the Bottom Line: Updating the Costs of Smoking in the Workplace 7.GPI Atlantic (2000-2003). Cost of Smoking 8.Health Canada (2009). Smoking and Your Body- Health Effects of Smoking 9.Health Canada (2008). Smoking and Your Body- Health Effects of Smoking 10.Health Canada (2008). Smoking Cessation in the Workplace- A Guide to Helping your Employees Quit Start Living Healthier

42. References 11.Health Canada (2008). Second-hand Smoke. 12.Health Canada (2007). Smoking Diseases. Health Effects of Smoking 13.Health Canada (2007). Towards a Healthier Workplace: A Guidebook on Tobacco Control Policies. 14.Health Canada (2007). Rewards of Quitting 15.Moskowitz, J.M., Lin, Z. and Hudes, E.S (2000). The impact of workplace smoking ordinances in California on smoking cessation. American Journal of Public Health 16.New Zealand Ministry of Health (2007). New Zealand Smoking Cessation Guidelines. 17.Pelletier B, Boles M, Lynch W. Change in health risks and work productivity over time. J. Occup Environ Med. 2004; 46 (7): 746-754. 18.Rehm, J. et al. (2006). The cost of substance abuse in Canada, 2002. Canadian Centre on Substance Abuse” 19.World Health Organization (2003). An international Treaty for Tobacco Control. Start Living Healthier