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

2. 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

3. 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

4. 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

5. 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% ( );
and, Mortality- decreased by1.8% ( )
"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

6. 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:
2. Hapren MT, Shikiar R, Rentz AM, et al. Impact of smoking status on workplace absenteeism and productivity. Tobacco Control. 2001;10:
Corporate Workshop
New Delhi. 10 Feb. 09

7. 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 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

8. 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 January 2009.
Corporate Workshop
New Delhi. 10 Feb. 09 8

9. 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

10. 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

11. 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

12. 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

13. 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

14. Thanks Questions? Reference- www.cancer.org
Contact-
Call
I thank you all for your attention.
Corporate Workshop
New Delhi. 10 Feb. 09