A Comprehensive Approach to

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

2. Start Living Healthier

3. Smoking and Human Health Smoking – An Addiction to Nicotine Why Consider Stopping Smoking? Why Should Unions Support Stop Smoking Programs in the Workplace? What Supports Can be Provided in the Workplace and What is Ideal? How Can Unions Support and Promote Stop Smoking Programs in the Workplace? 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 bulletsto smoking cessation. Access and evidence to support cessationcounselling were not available. The effect of smoking on workplacehealth and productivity is currentlywell 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 cancerthan 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 Rates by Occupation in Canada Start Living Healthier

10. 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

11. Smoking – An Addiction to Nicotine Start Living Healthier

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

13. PHYSICAL PSYCHOLOGICAL EMOTIONAL BEHAVIOURAL Start Living Healthier

14. 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

15. 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

16. Smoking Cessation…Myths and Misconceptions “Stop smoking programs 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

17. Why Should Union Members Consider Stop Smoking Programs? Start Living Healthier

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

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

20. Stop Smoking SupportCost Savings Based on1 pack per day,$10 per pack Start Living Healthier

21. Stop Smoking SupportCost Savings Half a year of groceries 1 family trip down south 146 DVDs With the money saved after 1 year… 50’’ plasma big screen TV 122 tanks of gas Half semester of tuition 12 ipods Start Living Healthier

22. Why Should Unions Support Stop Smoking Programs in the Workplace? Start Living Healthier

23. Why Help? Unions can be a champion in promoting and advocating for the health of its members (smokers and non-smokers alike) Stop smoking programs could be one of the most effective supports Member smoking affects union contract negotiations as employers seek to offset the costs associated with smoking(e.g., sick days, insurance) Start Living Healthier

24. Why Help? Smoking Cessation is Challenging: Many union members face work stresses and use nicotine to cope Workplaces that permit smoking on site makes stopping smoking especially difficult Some members hold multiple jobs, do shift work, or have transportation challenges and therefore can only access stop smoking support when held on-site, during multiple shifts or via telephone Second hand smoke can causes health risks for non-smoking members Start Living Healthier

25. Impact on Members Increased Insurance Premiums Poor Health Smoking Union Member Less Disposable Income(used on cigarettes) Social Stigma Start Living Healthier

26. What Supports can be Provided in the Workplace andWhat is Ideal? Start Living Healthier

27. 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 deliverprograms, supports and activities off-siteand providing self-help materials Education & Information • Provision of educational self-help materials Start Living Healthier

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

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

30. Supporting Smoking Cessation Smokers are 2-3 times more likely to succeed with supportthan without Stop smoking rates increase when a workplace smoke free policy (restriction) is implemented • Over 26% of the smokers who wereprohibited from smoking at work hadstopped smoking in the past 6 months,compared to 19% without ano smoking policy Start Living Healthier

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

32. A Comprehensive ApproachConsiderations 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

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

34. A Comprehensive ApproachConsiderations 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

35. 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 representunion management, union members, etc. Start Living Healthier

36. 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

37. How Can Unions Support & Promote Stop Smoking Programs in the Workplace? Start Living Healthier

38. Smoke Free Worksites / Workplaces Unions can lead in… Negotiating for a formal written no-smokingpolicy if none exist at worksites Negotiating to strengthen an existing no-smoking policy Adopting resolutions in support of smoke-free workplace policies Start Living Healthier

39. Health Benefits Unions can lead in… Negotiating for comprehensive stop smokingtherapy in member health benefits Negotiating for improved coverage Subsidize nicotine replacement therapyand cessation medication drug coverage Eliminating lifetime maximum coverage Improving access to counselling support: Group counselling One-on-one counselling Smokers Helpline Start Living Healthier

40. Member Needs Unions can lead in… Working with managementand other key stakeholdersto ensure the needs ofmembers are met Start Living Healthier

41. Promotion Unions can lead in… The promotion of the benefitsof the program to its members Start Living Healthier

42. Summary Areas in which unions can lead and support its members in stopping smoking: Smoke-free worksites/workplaces Negotiating for comprehensive smoking cessation health benefits Understanding and advocating for the needs of members around stop smoking support Promotion of stop smoking programs Start Living Healthier

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

44. References • Canadian Cancer Society (2008). Effective Workplace Tobacco Cessation Interventions • Canadian Cancer Society (2008). Tobacco Statistics in Canada; Health Canada (2007). Smoking Diseases. Health Effects of Smoking. • Canadian Cancer Society (2008). Second Hand Smoke is Dangerous. • Canadian Lung Association. Making Quit Happen. • Conference Board of Canada (2008). How Canada Performs: A Report Card on Canada Health Overview • Conference Board of Canada (2006). Smoking and the Bottom Line: Updating the Costs of Smoking in the Workplace • Health Canada (2008). Smoking Cessation in the Workplace- A Guide to Helping your Employees Quit • Health Canada (2008). Second-hand Smoke. Start Living Healthier

45. References • Health Canada (2008). Smoking and Your Body- Health Effects of Smoking • Health Canada (2007). Rewards of Quitting • Health Canada (2007). Towards a Healthier Workplace: A Guidebook on Tobacco Control Policies. • Health Canada (2003). Canadian Tobacco Use Monitoring Survey. 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 • New Zealand Ministry of Health (2007). New Zealand Smoking Cessation Guidelines. • Rehm, J. et al. (2006). The cost of substance abuse in Canada, 2002. Canadian Centre on Substance Abuse” • World Health Organization (2003). An international Treaty for Tobacco Control. Start Living Healthier