Best Practices for Tobacco Cessation in the Workplace: The Basics and What’s New!

1. Best Practices for Tobacco Cessation in the Workplace The Basics and What’s New! Laura Loew Certified Tobacco Treatment Specialist President Smash the Ash! (330) 636-6347 laura@smashtheash.com 2014

3. Today’s talk will include: • What is Tobacco Treatment? • Best Practices to help employees quit • Helpful resources • ACA guidance • Time for questions • How many here are employers? • How many are brokers/insurers? • Vendors? • Any other categories? • Anyone here a tobacco user? (It’s OK!)

4. A. . . What?

5. My Background: • Ex-smoker! Began facilitating tobacco cessation programs 2007 • Tobacco Treatment Specialist Certification from Mayo Clinic, 2008 • Tobacco Cessation Coordinator, Medina General Hospital, 2007 - 2010. • Pfizer physician trainer and Quit Clinic leader 2009 - present • Smash the Ash! 2010 to present - Workplace Cessation. Lead a team of Certified Tobacco Treatment Specialists and other wellness advocates. Individual and group cessation programs, policies, health fair booths and educational sessions. • Primary Prevention Chair, American Cancer Society, Medina, Ohio 2008 - 2013. • Have personally helped over 875 people become tobacco-free and love what I do!

6. Half of all long-term smokers will die a tobacco-related death. Mayo Clinic 50% Tobacco use will claim one billion lives this century. World Health Organization One billion 20,000 Ohioans die from tobacco-related illnesses every year American Cancer Society 20,000 Each smoker costs his/her employer $5816 per year more than a nonsmoker. The Ohio State University, 2013 $5,816

7. Tobacco Tidbits • Tobacco is the only product legally on the market when, as used as directed, will kill half its users • Most tobacco users start in their teens (some as young as 6 or 9 years old) when judgment and adult decision making is still years off • Most people are truly addicted to nicotine • Nicotine changes tobacco users’ brains • Most people CAN quit. Maybe not easily, or maybe not the first time they try, but they can quit.

8. Tobacco use I see: • Cigarettes • Smokeless tobacco • Cigarillos - little cigars • E – Cigarette • Hookah • Cigars • Pipes

9. My clients (workplace cessation). . . • Employed adults • “Healthy” users • “Want” to quit? • Age 45 + • Using tobacco for 30+ years • Low SES (KEY to estimating tobacco use percentages) • All races • More men than women (60/40)

10. 2 KEY WORDS. . . Positive And Supportive!

11. Set a better example Health $$$ Their employer doesn’t allow smoking on their property or they pay more in insurance costs if insured Tobacco users probably already know WHY they should quit. Family/friends want them to quit Tired of it controlling them Tobacco users are looked down upon

12. They DON’T know why is it so hard to quit. . . And neither does their employer. Nicotine is one of the strongest addictive substances Brain receptors release dopamine (DO THIS MORE!!!) Need to treat addiction AND habit/behavior/stress management/coping (in a POSITIVE and SUPPORTIVE manner) for highest longterm quit rates. TOBACCO ADDICTION IS THE NATION’S NUMBER ONE HEALTH CRISIS . . . And thus an employer’s number one chance to save money and improve the health of their workers.

13. Is Nicotine Carcinogenic?

14. 7 First Line Therapies Approved by FDA • NRT OTC (Patch, Gum, Lozenge/Mini-Lozenge • NRT RX (Inhaler, Nasal Spray) • Chantix (varenicline) • Zyban (bupropion, aka Wellbutrin) • Combination therapy, under guidance from CTTS, facilitates best quit rates

15. Support and Behavior How many repetitions does it take to form a ‘habit’? How many times have your employees reinforced their tobacco use? Tobacco use is a ‘stress reliever’ but a low-effort coping mechanism.

16. Alternative “Treatments” • Acupuncture/Laser? • Hypnosis? • E-Cigarette?

17. Tobacco use is classified as a chronic, relapsing disease.This is NORMAL! You must make the quit attempt the BEST and therefore LAST attempt to quit. Use evidence-based treatment plus support!

18. Cessation Becomes The Employer’s Burden American Cancer Society

19. Why Onsite Group Cessation Works • Easy and convenient for employees • Replaces negative peer pressure with positive • Credible program using outside experts • Employees appreciate concern for their health (can’t get this benefit anywhere else) • Competitiveness and accountability to group • Uses recognized, evidence-based programs (PATH) • FACE TO FACE is better. (This talk vs. webinar)

20. “But we don’t have a lot of smokers!” General population in Ohio: 21% ‘smokers’ Hourly workers in Ohio: estimate 50-60% tobacco users Epidemic of smokeless use: many dual users, switchers, or hidden users

21. “Our smokers don’t want to quit!” CDC: 70% want to quit! THEY PROBABLY DON’T KNOW HOW! The ‘early adopter’. . .

22. “We already offer a telephonic or online program through our insurance company!” How many tobacco users have called? How many callers have quit? How are quit rates calculated? Do they offer support for quitting smokeless tobacco? Evidence-based program? Using Certified Tobacco Treatment Specialists? Onsite? Off-shift? CO monitoring? NRT samples? Ongoing support?

23. Options when Designing Workplace Tobacco Cessation Programs • Start with Lunch and Learn, or Health Fair Booth (non-threatening, lower • investment) • Onsite quit program – company pays. . and may hold classes on the clock • Onsite program includes spouses and/or adult children • Designate a tobacco-free campus; have policy written • Charge non and ex-smokers less for insurance (affidavit vs. testing) • Pay for NRT and prescription medications for quitting. . . AND • cessation classes. . . as many times as needed. Even if grandfathered. • Don’t hire tobacco users?

24. Employer Testimonial Mike Patalita, Site Manager Do-it Best Corp, Medina I can't put a dollar figure on the savings. But I feel very confident that were are helping our employees live healthier lives. We demonstrated in a tangible way that the company cares about its employees. I think the most frequent positive comments that I heard were that staff felt the company cared about them by providing (paying for) the class. They thanked me personally. . . .The group format provided a built in support system, and some competition for those that respond well to that. I was very pleased with the quit rate. Laura, your energy was the biggest key to the high success rate. . . You. . showed your level of caring about the class. They didn't want to let you down. You rock!

25. ACA Guidance • What are plans expected to provide as preventive coverage for tobacco cessation interventions? • The plan must cover, without cost-sharing: • Screening for tobacco use; and, • At least two tobacco cessation attempts per year. For this purpose, covering a cessation attempt includes coverage for: • Four tobacco cessation counseling sessions of at least 10 minutes each and • All Food and Drug Administration (FDA)-approved tobacco cessation medications for a 90-day treatment regimen Based on the Clinical Practice Guideline, Treating Tobacco Use and Dependence: 2008 Update http://www.dol.gov/ebsa/faqs/faq-aca19.html

26. Resources for Tobacco Treatment Information Association for the Treatment of Tobacco Use and Dependence www.attud.org www.treattobacco.net American Cancer Society (free literature) American Lung Association Tobacco-Free Kids www.tobaccofreekids.org Tobacco Cessation Leadership Network www.tcln.org Bringing Everyone Along (MH/SUD)

27. Resources for Tobacco Users Legacy www.becomeanex.org SmokefreeTxt http://smokefree.gov/smokefreetxt Mayo Clinic “My Path to a Smoke Free Future” Kill the Can (smokeless quitting) www.killthecan.org Nicotine Anonymous (check for local groups) 1-800-QUIT NOW

28. Thank you! Questions? I am always available to meet with you to discuss my favorite topic! (no obligation!) Laura Loew, CTTS Smash the Ash! (330) 636-6347 laura@smashtheash.com