A booklet for employers that discusses the reasons for having a smoking cessation program, and steps and advice on setting one up.Part of a collection. Click on the 'collection' button to access the other items.
About This Booklet
The California Labor Code requires all indoor worksites to be smoke-free. A construction site is considered “indoor” when there are four walls and a ceiling. But increasing numbers of outdoor worksites are also going smoke-free for a variety of reasons. Refineries have always enforced smoking restrictions, but now some school districts, hospitals, and construction projects in high-fire areas are also becoming smoke-free both indoors and outdoors.
If a worker who smokes goes to a non-smoking worksite, he or she has two choices: start chewing tobacco to satisfy the cravings or quit, at least during working hours. Since chew is at least as addictive as cigarettes and can lead to oral cancers, quitting is clearly a better option — for the worker and his or her family, for the employer, and for the Health and Welfare Trust Fund.
The purpose of this guide is to help construction employers establish worksite tobacco cessation programs that will benefit your employees and your own bottom line.
Table of Contents
Cessation Programs Are Good Business
The Workplace Cessation Toolbox
Employer Programs That Work
Options for Your Worksite
Evaluating Outside Providers
Cessation Programs Are Good Business
Tobacco Is a Health and Safety Issue
Most employers care about the health and safety of their workers and emphasize safety on the job. You design jobs to be as safe as possible, provide personal protective equipment, and hold regular safety meetings. But did you know that tobacco is a greater cause of death and disability than any other hazard in the workplace?
- Of the more than 4,000 chemicals in tobacco smoke, at least 50
have been linked to cancer, heart disease, and other illnesses.
- Tobacco adds to the effects of other toxic substances found on the job. For example, an asbestos worker who doesn't smoke has 5 times the risk of lung cancer as the general population, but the risk jumps to 50 times for an asbestos worker who smokes.
Getting the job done on time and on budget is your top priority. But did you know that workers who smoke may negatively impact your bottom line? According to national studies:
- Smokers have higher absenteeism rates, averaging 34% more
absences from work than non-smokers. Non-smokers exposed to
secondhand smoke also have a higher rate of illness.
- Smokers are 29% more likely to have industrial accidents and 40%
more likely to suffer injuries at work. This translates into higher
health insurance, life insurance, and workers’ compensation claims.
- 6 to 12% of health and welfare fund costs are for treating
smoking-related illnesses — that’s your money.
- Employees who smoke (on or off the worksite) can cost employers up to $2,000 a year.
- Health and fire insurance premiums can be 25 to 35 percent lower for smoke-free businesses.
Workers Want To Be Healthy
Polls show that more than 70% of smokers would like to quit. Almost 50% of smokers try to quit for at least one day a year.While building trades workers smoke at a rate that is 60 to 87 percent
higher than the general population, depending on the trade, they want to quit just as much as
other smokers.When designed to meet their needs, smoking cessation programs attract as many
construction workers as any other population group.
Focus groups and interviews show that most union construction workers expect to be able to quit without help. In some cases, smokers can quit on their own. But most smokers need help. Often smokers end up quitting because they have a serious health event that’s caused by their smoking. We can do better than that. We can offer smoking cessation programs that help smokers quit before they become sick.
Cessation depends upon repeated attempts. Nicotine may be the most addictive drug known to man and it is very difficult to “just quit.” Those who quit successfully have made an average of six or seven attempts.Many smokers don’t realize this. After one or more failed attempts they become fatalistic and believe they can’t quit. By providing positive reinforcement we can counter such beliefs.
Smoke-Free Worksites Encourage Cessation
Construction workers try to quit as often as white-collar workers, but have a much lower success rate. One reason is the lack of a supportive work environment. By providing a smokefree workplace and encouraging smoking cessation, you’ll go a long way toward providing a supportive environment. You’ll also have a healthier crew and save money.
People need to be educated, encouraged, and supported through repeated quit attempts. Working environments that encourage cessation are key to a worker’s ability to quit. Tobacco cessation is the most cost effective health program there is. For every dollar spent on smoking cessation programs, there is a return of $15 in reduced medical expenditures alone.
The Workplace Cessation Toolbox
Quitting tobacco is not easy because the nicotine in cigarettes and chewing tobacco is a very addictive drug. Most people attempt to quit “cold turkey” but only 3% succeed without help. National Clinical Guidelines for smoking cessation document the effectiveness of various types of smoking cessation programs. Many programs and products are available that will increase the success rate substantially. These can generally be divided into six types:
|Self-Help Programs||These are available over the internet or by mail, and are attractive to many smokers because they offer privacy and flexibility. Many self-help materials (booklets, videotapes, and quit kits) are appropriate for use as part of a worksite program. Good self-help materials should provide employees with information to help understand their smoking patterns, set quit dates, identify and resist smoking cues, explore alternatives to smoking, control weight gain, manage stress, and prevent relapse.|
|Group Programs||Some smokers need the guidance and support provided by structured programs. Group meetings offer reinforcement and counseling. The individual goes through the step-by-step quitting process with the help of the group and its leader. The employer may bring outside providers to the worksite to conduct group programs, or workers can be given a list of programs in the community.|
|Telephone based Programs||The most effective smoking cessation programs for construction workers have been telephone-based counseling programs. They are well received because they are convenient (pick up the phone!) and very private. In many cases, health and welfare funds contract with private providers to offer telephone-based counseling to their participants. California offers the California Smokers’ Helpline, which is a free and confidential telephone-based counseling program. Its toll-free number is 1-800-NO BUTTS.|
Because nicotine is a physical addiction, many smokers are better
able to quit with Nicotine Replacement Therapy (NRT) products.
In fact, the most recent National Clinical Guidelines on smoking
cessation recommend that smokers who try to quit use these aids
unless they have a medical condition that prohibits using them.
These aids include nicotine gum, nicotine patch, nicotine inhaler, or
other FDA approved products. Many of these are available without a
prescription. Some smokers also can benefit from the anti-depressant
drugs Zyban® or Welbutrin®, which require a prescription. NRT and
other drugs should always be used in combination with a quit
|Incentives||Special incentives can be very effective in increasing employee interest in quitting. They give employees a positive focus, reinforcing motivation and encouraging participation in cessation programs. Even small rewards or recognition, such as in a company newsletter, can help smokers succeed.|
|Alternative Approaches||These include hypnosis, acupuncture, and herbal supplements. There are no studies documenting the success of these methods.|
A successful cessation program provides many different approaches to quitting. At a minimum, a successful cessation program will offer these three elements:
- Access to information and educational materials
- Access to Nicotine Replacement Therapy (NRT)
- Counseling, either individual or group, in person or by telephone.
- No limits on the number of times a smoker can try to quit. We want to encourage smokers to try over and over. The more times they try, the more likely they are to quit!
- No deductibles or co-payments. Such costs can give smokers an excuse not to try. Even very small co-payments lead to much lower participation rates.
Offering tobacco cessation to employees is neither new nor revolutionary. Many companies are currently offering comprehensive programs. BUILT does not endorse any specific program, but highlights some successful worksite programs as examples of different approaches.
||This cessation program, developed jointly by labor and management,
received the 2002 National Achievement Award of the American
Association of Health Plans.
The Fund is a union-employer Taft Hartley health and welfare fund that covers 10,000 union workers and many employers. To date it offers the only cessation program designed for a multi-employer group.
The Fund’s plan offers an unlimited smoking cessation benefit covering telephone counseling provided by Free & ClearSM and smoking cessation medications, including NRT and Zyban®.
The Free & ClearSM Program is delivered over the course of one year. It provides each participant with educational materials, self-help materials, continuing telephone interventions with a personal cessation specialist, access to a toll-free Quitline, and access to the tobacco cessation website www.quittobacco.org. This website gives participants tips and support to reinforce the information they get from the telephone counseling sessions. Recommendations for Nicotine Replacement Therapy are provided when appropriate. Evaluation of this program shows that it is effective for building trades workers. The program had a 12-month quit rate of 27.5% at a cost of one-half cent per hour contribution to the trust fund. Most importantly, 95% of participants say they recommend the program to friends and co-workers.
|This large national company has chosen to develop its own in-house
program. The BOB (Butt Out and Breathe) program was awarded
the C. Everett Koop Health Award in 2001. Smoking among Union
Pacific employees dropped from 40% to 26% in eight years.
Each Union Pacific employee can use BOB twice in a lifetime. To start, employees complete a “readiness to quit” questionnaire. BOB then provides them with a 90-day prescription for Zyban®. Nicotine Replacement Therapy (patch, gum, inhaler) is also available for a five dollar co-pay. The program provides follow-up for six months, and an incentive program that includes a drawing. The program has “health coaches” who offer personal telephone follow-up, a website, reminder notes every two weeks, and literature on quitting smoking or chew. BOB is run by a third-party medical provider to ensure confidentiality.
Since BOB is part of Union Pacific’s larger health education program, employees are able to go to health clubs for free with the company’s membership plan.
|Bath Iron Works
This Maine shipyard is a single-site company with 6,500 workers
represented by four different unions. The smoking rate among
workers is more than 10% higher than the state’s average. The
company’s program combines in-house efforts with outside
resources. Union representatives and company management have
crafted a health education program called “Building Healthy Ways” which includes tobacco education and cessation.
|Johnson & Johnson
||One of the world’s largest health products companies, Johnson &
Johnson has a very active health promotion program for its
employees that includes many different tobacco cessation plans.
Several Johnson & Johnson facilities make available the Smoke Stoppers® cessation program. This is a 21-day program with userfriendly materials that give information, techniques, and strategies to stop smoking in a day-by-day format. Participants also designate a personal “Smoke Stoppers Coach” who can be a family member, friend, or co-worker they work with as they go through the quitting process. The coach is provided a guidebook. Smoke Stoppers® also recommends the use of Nicotine Replacement Therapy and/or nonnicotine medication (Zyban® or Welbutrin®). A study of blue-collar Johnson & Johnson union workers in Chicago showed 40% of smokers enrolled in this program were able to quit.
Another effort, at a Johnson & Johnson manufacturing plant in Florida, uses two programs. The American Cancer Society’s Fresh Start® is a group program. It consists of four sessions held during a two-week period. Employees participate in activities that introduce the most effective elements for success. The plant also uses Health Enhancement Systems’ Tobacco-Free Wellstage Program, which provides information and cessation activities based upon a theory of stages of change. 70% of smokers at the plant attended at least one class in this program. 45% completed the program and 22% are still tobacco-free.
Options for Your Worksite
Once you have decided to provide cessation services, there are a number of other decisions to make.
|First ask these questions||
Here are a few options
Free to low cost
Low to moderate cost
EVALUATING OUTSIDE PROVIDERS
Consider these questions before you contract with an outside organization:
- How long has the organization been in existence? How long has it been providing smoking cessation programs?
- How many people have gone through the program?
- Will the approach be appropriate for your employees?
- What methods are used to help smokers quit?
- How is maintaining abstinence from smoking addressed?
- What resources will be provided to help promote the program to your employees and stimulate participation?
- Have others been satisfied with the program?
- Will the program provide a list of clients?
- Will the program provide references?
- What are the qualifications of the instructors? What training have they received? What is their cessation counseling experience?
- Are printed materials appropriate for the educational level of your employees? Are they attractive and motivational?
- Will the structure of the program accommodate the needs of your employees? Can the provider:
- accommodate all shifts?
- provide on-site and off-site programs?
- structure flexible program formats?
- provide audio or visual materials and equipment?
- Is the program provider willing to offer ongoing assistance and follow-up once the formal program ends?
- Does the program use the participants’ existing support systems, such as peers and family members?
- Does the program offer any form of guarantee? For example, can employees repeat the program for free or at a lower cost if they don’t quit the first time, or have a relapse?
- How does the program plan to establish eligibility so you only pay for your workers and not others?
- Will the program supply you with monthly data reports so that you can evaluate how well it is doing and whether it needs to be changed?
- Can the provider supply evidence of six-month and one-year success rates among previous clients with a background similar to your employees? A range of 20-30% success rate is realistic. Remember: if it sounds too good to be true, it probably is.
- How much does the program cost per employee? Are group discounts available?
Whatever services you are able to offer your workers, remember:
Smoke-free worksites encourage cessation.
Tobacco cessation is the most cost effective health program available.
Providing a smoke-free worksite along with tobacco cessation services will be enormously beneficial to your employees and to your business.
American Cancer Society: Fresh Start
1-800-ACS-2345 or call your local American Cancer Society office.
Group cessation program.
Cost: Call local ACS office.
American Lung Association:
Freedom From Smoking™
Self-help manual and cessation clinics, audiotapes, 7 Steps to a Smoke Free Life book, online step-by-step
Cost: Online program free, book $14.95, or contact your local ALA office for other information.
California Smokers Helpline
1-800-NO BUTTS (1-800-662-8887)
Telephone counseling, educational materials.
Free and ClearSM
Self-help materials, telephone counseling, pharmaceuticals.
12 step program for tobacco cessation. Group support and recovery.
Cost: Group attendance: Free.
Books and pamphlets at nominal
Northwest Carpenters Trust Fund
Comprehensive program with telephone-based counseling and NRT/Zyban™ for construction
union health and welfare fund.
Cost: 0.5 cents per hour of contribution (roughly $12 per FTE).
Quit and Win
Sponsored by the World Health Organization, this international tobacco cessation contest provides
prizes for quitting. Go to website for prize information.
Internet self-help, telephone counseling, 21-day QuitKit program, business programs.
Cost: $39 for the internet program, or contact group for information about other programs.
This self-help quit program offers brochures in a“stages of readiness” format.
Cost: Varies depending on brochure and quantity. See website.
916-443-3302 • www.sbctc.org/built
Can provide information on tobacco for tailgate safety meetings, “check stuffers” to promote the California Smokers Helpline, and signs in different languages to communicate your worksite’s tobacco policies.
Internet-based Programs and Resources
Individual self-help internet program.
This website is created by GlaxoSmithKline, the maker of Nicorette® and NicoDerm®.
Individual self-help internet program.
A combination of cessation sites,WhyQuit emphasizes “cold turkey” and discourages NRT.
Individual self-help internet program.
Sponsored by the Massachusetts Department of Public Health.
A Spit Tobacco Cessation Website
A self-help internet program for spit tobacco users.
PACT (Professional Assisted Cessation
PACT is a consortium of smoking cessation professionals. This website includes an Employers’ Smoking Cessation Guide in pdf, and a wealth of other information.
CDC – National Center for Chronic Disease
Prevention and Health Promotion
The CDC has tobacco facts, the Surgeon General’s Reports, research and data, and educational materials. Be sure to read Making Your Workplace Smoke-Free – A Decision Makers’ Guide.
Many other cessation services may be available in your community. Find out about other local resources by contacting your local Public Health Department and/or hospitals.
Building Trades Unions Ignite Less Tobacco
BUILT is a statewide program sponsored by the State Building and Construction Trades Council of California. Funded by the California Department of Health Services, BUILT strives to promote smoking cessation and prevention among construction workers and create smoke-free work environments.
BUILT reaches union members through:
- Local Unions, who distribute educational materials to their members
- Health and Welfare Trust Funds, who provide information about tobacco and the benefits of quitting smoking
- Joint Apprenticeship Training Committees, who include information about tobacco and toxic hazards in their health and safety training for apprentices
- Labor-Management Committees, who develop worksite tobacco policies.
For information about BUILT and our other programs:
PROJECT DEVELOPMENT TEAM
This guide was made possible by funds received from the Tobacco Tax Health Protection Act of 1988-Proposition 99, under Grant Number 99-85070 with the California Department of Health Services, Tobacco Control Section.
Produced by BUILT, State Building and Construction Trades Council of California
in collaboration with the Labor Occupational Health Program, UC Berkeley