1. Community and Worksite Systems Myra Muramoto, M.D., M.P.H. Dept. of Family and Community Medicine University of Arizona

2. Product / Service  Communities and worksites Commonalities – potential multi-levels of intervention/ delivery systems Commonalities – potential multi-levels of intervention/ delivery systems Differences – worksites more closed populations, controlled environments, homogeneous populations Differences – worksites more closed populations, controlled environments, homogeneous populations  Community - whole community vs. individual programs/services  Worksites – whole workforce vs. individual  Treatments offered - predominately psychosocial/behavioral, also pharmacologic and combined  Tremendous variability in format, intensity

3. Populations  Community-level Potentially reaches more of target population with mass media, multi-channel approach Potentially reaches more of target population with mass media, multi-channel approach  Community-based May have better reach into some underserved populations May have better reach into some underserved populations Capacity potentially limited by medication access, number of service providers Capacity potentially limited by medication access, number of service providers  Worksites May reach younger male population May reach younger male population Potential for high frequency/intensity of contacts Potential for high frequency/intensity of contacts Capacity potentially limited Capacity potentially limited

4. Places and Providers  Community-based services Access - direct access and via referrals Access - direct access and via referrals Located in the community, off-work hours Located in the community, off-work hours Providers are community members, potentially more culturally acceptable services Providers are community members, potentially more culturally acceptable services  Worksites Access – usually on-site, both during and outside of work hours Access – usually on-site, both during and outside of work hours On-site more convenient, less private On-site more convenient, less private Providers can be company employees (employee health, EAP) or outsourced to contractor Providers can be company employees (employee health, EAP) or outsourced to contractor

5. Price  Community services – price variable Free, if tobacco tax/MSA supported Free, if tobacco tax/MSA supported Independent/private providers charge Independent/private providers charge Agencies usually charge Agencies usually charge Insurance coverage – full or with co-pay Insurance coverage – full or with co-pay Non-monetary costs – time, travel Non-monetary costs – time, travel  Worksites Usually no financial cost to employee Usually no financial cost to employee On-site convenience may reduce non-financial barriers On-site convenience may reduce non-financial barriers May have employer incentives to participate/quit May have employer incentives to participate/quit

6. Promotion  Community-level – mass media, multi-channel  Community-based services Advertising – paid and public service, print and broadcast, bill boards Advertising – paid and public service, print and broadcast, bill boards Quit line referrals, healthcare system referrals Quit line referrals, healthcare system referrals  Worksites - highly variable Passive - presentations, health fairs, mail/e-mail Passive - presentations, health fairs, mail/e-mail Proactive/Interactive - employer incentives, contests, health risk assessments Proactive/Interactive - employer incentives, contests, health risk assessments

7. Policy  Community-based How is service funded (e.g. free vs. fee)? How is service funded (e.g. free vs. fee)? Access to medication provided (free/discount)? Access to medication provided (free/discount)? Linked to insurance benefit (e.g. medication)? Linked to insurance benefit (e.g. medication)?  Worksites Employer incentives (negative or positive reinforcement) ? Employer incentives (negative or positive reinforcement) ? Tobacco/smoking bans enforced? Tobacco/smoking bans enforced? Costs to worker (time or money)? Costs to worker (time or money)? Access to medication? Access to medication?

8. Key Opportunities for Innovation  Shift “culture of quitting” norms about Seeking cessation help Seeking cessation help Enhancing motivation to quit Enhancing motivation to quit  Engage, activate “concerned others” and “health influencers” Information – media, web, quitlines Information – media, web, quitlines Education and training – classroom, web, quitlines Education and training – classroom, web, quitlines  Need a better understanding of what consumers want  Develop a range of cessation services that are accessible, acceptable, affordable, integrated  Expand pool of cessation service providers

9. Questions?Discussion?

10. Thoughts from concerned others “Someone I Know…” “Someone I Know…” In this activity, participants identify a person they know who smokes. They are then asked to write down a few thoughts about that person. These are a few entries from web-based participants. In this activity, participants identify a person they know who smokes. They are then asked to write down a few thoughts about that person. These are a few entries from web-based participants.

11. Someone I know… Tim “The father of my children and the person I want to spend the rest of my life with. He’s wonderful and he wants to quit smoking, but he can't.” -Reach WBT participant

12. Someone I know… Karen “I love her. She is my sister and she's a chain smoker and so is her husband. They have two young children…. I don't want her to die from smoking like my dad did.” -Reach WBT participant

13. Someone I know… Karl “I love Karl. He is my son, and it is painful to watch him, in a sense, commit slow suicide by smoking. He is well-aware of the associated risks, but is having an incredibly difficult time stopping. He has tried several times. A part of me is angry at him because I hate the smell of cigarettes. Also, I am allergic to the smoke and wish he could at least refrain from smoking in the house where I am effected by it, as well.” -Reach WBT participant

14. Someone I know… Gary “ He is a wonderful person. A good father and husband. A good friend to many and an excellent coworker. He has so much to give to others, but he is most likely cutting his life short. He has lost his mother to cancer from tobacco use, two aunts and an uncle all from tobacco use. I wish he could change for his family’s sake.” -Reach WBT participant -Reach WBT participant

15. Someone I know… John M. “He could not quit. He was highly addicted. He died before the treatments and information was available to really give him a chance at quitting. He suffered greatly in the end. He did what he said he was going to do,’I am going to smoke until I die.’ " “He could not quit. He was highly addicted. He died before the treatments and information was available to really give him a chance at quitting. He suffered greatly in the end. He did what he said he was going to do,’I am going to smoke until I die.’ " -Reach WBT participant