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PRESENTED BY:

Carving Tobacco Cessation

Out of Wellness:Make a Real Impact on Tobacco Use in Your Organization


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TABLE OF CONTENTSExecutive Summary .............................................................................................. 3

What You (Might Not) Know About Tobacco ........................................................ 4

We Know We Must Address Tobacco Use .......................................................... 5

The Wellness Umbrella Has a Hole: Its Called Addiction .................................... 6

The Solution: Evidence-Based, Specialized Programs ........................................7

Evidence Base ................................................................................................7

Integrated Modalities ......................................................................................7

Personalized Approach .................................................................................. 8

Medication Support ........................................................................................8

Capacity to Allow Multiple Quit Attempts ......................................................9

Why Dont People Switch? .................................................................................. 10

Myth #1: Our population is unreachable. ................................................... 10

Myth #2: Vendor integration is always difcult. ......................................... 11

Myth #3: Specialized programs are too expensive. .................................. 11

Employer Engagement ........................................................................................ 12

Oer a Supportive Environment ................................................................... 12

Reward Employee Engagement ................................................................... 13

Communicate Clearly and Eectively .......................................................... 14

Conclusion .......................................................................................................... 15About Us ............................................................................................................. 16

Carving Tobacco Cessation Out o Wellness: Make a Real Impact on Tobacco Use in Your Organization


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Executive SummaryIts tempting to believe that one program can help everyone, but when it comes to quittingtobacco, the traditional one-size-fts-all approach to wellness just doesnt cut it. Unlike

other liestyle changes people make that require gradual behavior modifcations over a

lietime, quitting tobacco requires intensive planning, correct use o medications, and skills to

overcome the emotional, physical, and psychological impact o giving up nicotine, a powerul

substance shown to be just as addictive as heroin.

Tobacco cessation is still the most cost-eective beneft you can oer your adult employees,

but only i it generates positive outcomes. I you want to make a real impact on tobacco use

in your organization, its time to consider carving your tobacco cessation beneft out o your

wellness program and oering a specialized program that is evidence based and ollows

USPHS guidelines. With the help o such a program, tobacco users have a much greater

chance o successully quitting in a relatively short period o time, allowing them to turn their

attention to improving their overall wellness.

This white paper addresses the unique challenges o nicotine addiction, the tools necessary

to successully overcome it, and what to look or when choosing a specialized tobacco

cessation program or your organization.


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What You (Might Not)

Know About TobaccoWhat You Know About TobaccoYou know that tobacco use remains as the greatest cause o preventable death and disease

in the US, killing more than 440,000 people each year.

You also know that tobacco use costs us, and it costs us greatly. Employers alone spend over

$196 billion per year in excess medical costs and lost productivity on average an excess cost

o $21 per smoker, per day or $7,874 per year.

You know that secondhand smoke is deadly. Every year, thousands o nonsmokers die rom

heart disease and lung cancer, and hundreds o thousands o children suer rom respiratory

inections because o exposure to secondhand smoke.

What You Might Not Know About TobaccoThere are acts about tobacco, however, that you might not know:

The risks o smoking are much greater than those or any other health habit, including

obesity and alcoholism.

50% o long-term smokers who do not stop will be killed by smoking-related diseases.

The way tobacco is grown, mixed, and processed today has made cigarettes more

addictive than ever beore.

In the absence o any treatment, only 3-8% o smokers who make a quit attempt will

successully quit in any given year.

The decline in the prevalence o smoking has slowed in recent years; remaining smokers

are more addicted or have more problems quitting.

There has been a decline in number o cigarettes smoked per smoker, but the number o

social smokers has increased.

The 2010 Surgeon Generals Report, How Tobacco Smoke Causes Disease, shows that

there are more than 7,000 chemicals ound in tobacco smoke, hundreds o which are toxic;

at least 69 o which cause cancer.

The chemicals in tobacco smoke quickly damage blood vessels, leading to higher risk o

heart attacks, strokes, and aneurysms. Such chemicals also make it harder or diabetics

to control blood sugar and cause great harm to pregnant women and their babies.


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We Know We Must

Address Tobacco UseThese acts are staggering, but perhaps unsurprising. We know that tobacco use must be addressed at an

individual, employer, and public health level.

Today, the question or employers is not whether they should implement a tobacco cessation program.

We know the answer to that question is yes. Instead, employers need to ocus on the appropriate

characteristics o a successul program.

Now there are multiple questions to address Which program fts the needs o your employee population?

When is the best time to implement the program? And how much will it cost?

Many Employers Turn to General WellnessWhen aced with these questions, many employers seek out an all-encompassing wellness program which

addresses a variety o liestyle changes. They group tobacco cessation in with initiatives such as weight

loss, better nutrition, physical activity, and stress management.

While it is necessary to address each o these risk actors, especially in light o the nations obesity

epidemic, quitting tobacco is still the single most benefcial action a tobacco user can take. Fortunately, it is

a actor where individuals can beneft greatly rom specialized treatment.


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The Wellness Umbrella Has a Hole:

Its Called AddictionThe greatest dierence between tobacco cessation and other orms o health behavior modifcation

is the act that the dependence on nicotine is an addiction - one that has been shown to be just as

addictive as alcohol or heroin. This is because, just as with alcohol and other drug addictions, there

is oten a dependency on three levels - physical, emotional, and behavioral.

Physical Dependence on NicotineWhen inhaled in tobacco smoke, nicotine is absorbed quickly into the bloodstream and takes as little

as 7-10 seconds to reach the brain. There, nicotine interacts with nicotine receptors, which stimulates

the release o dopamine. This provides smokers with an immediate reward and allows them tobelieve they can better control their mood, concentrate better, and be less irritable. These benefts

are not real and may simply be due to relie o withdrawal symptoms rom not smoking.

When a person tries to quit tobacco, the withdrawal symptoms can be overwhelming. In addition

to bad mood, irritability and an inability to concentrate, he may have craving, insomnia, increased

hunger and restlessness. These symptoms oten last or several weeks.

Emotional Dependence on NicotineThe problems dont end there. Dependency on nicotine is also on a mental or emotional level. Many

people turn to the pleasurable eects o nicotine to help manage their stress, to socialize with others,or to celebrate.

Tobacco users begin to associate cigarettes with many types o emotional events - and it wont

be long beore they wont know how to handle a variety o emotions without the crutch o nicotine

to support them. Emotional withdrawal symptoms may include insomnia, eelings o anxiety or

depression, irritability, and eeling out o control.

Behavioral Dependence on NicotineNicotine addiction is also one o behavioral dependency. Since most smokers start beore the age

o 18, they oten develop behavioral patterns around smoking at an early age. This is where tobaccouse looks more like a habit - its something a person does while driving, watching TV, sitting at the

computer, talking on the phone, or while having a cup o coee. When he tries to quit smoking, a

person who has always reached or a cigarette when driving or fnishing a meal will likely associate

these times and events with a need to smoke.


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The Solution: Evidence-Based,

Specialized ProgramsOvercoming addiction to nicotine is difcult, but it is not impossible. The key to addressing tobacco use

in your organization is to address it at an individual level: you must oer an evidence-based, specialized

cessation program which addresses the physical, emotional, and behavioral strategies necessary to

overcome dependency on tobacco.

Evidence BaseAccording to the United States Public Health Services 2008 Clinical Practice Guideline update,

Treating Tobacco Use and Dependence, the most eective, evidence-based method or treating

tobacco dependence is a combination o counseling and medication. The program should be oeredby an experienced vendor that dedicates its resources to oering tobacco-using employees the intensive,

specialized support they need. Such a vendor will also leverage its experience to assist you in your eorts

to ensure ull organization-wide engagement with the tobacco cessation initiative at your worksite.

Integrated ModalitiesQuitting tobacco use takes a great deal o confdence and commitment, and every participant in a

tobacco cessation program will all be at a dierent point in the quitting process. In order to successully

quit, its important to provide a support system that is structured to educate and oer support at every

step in the program. Here are some o the key elements to look or in an integrated program:

Dedicated coaches. An evidence-based tobacco cessation program employs specially

trained treatment specialists oten known as coaches who teach tobacco users how to

overcome physical cravings with the correct use o medications, teach new ways o thinking

about tobacco to control the emotional and psychological responses to withdrawal, and show

how to develop behavioral strategies or overcoming triggers in everyday situations that used

to involve tobacco.

Supplemental educational tools. Another important component o a specialized program

is the provision o supplemental educational pieces such as printed materials or online learning

tools. These tools actively engage tobacco users between counseling sessions, reinorcing and

expanding upon the inormation learned rom their coaches.

Social support. An eective program will be structured to oer consistent social support,

whether rom the coaches themselves, through an online community, or a combination o the two.


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Personalized ApproachA personalized approach is crucial to the quitting process. A good program will provide coaches

who are trained to the Core Competencies o the Association or the Treatment o Tobacco Use andDependence and who are prepared to speak with each tobacco user about her specifc needs.

Specialized coaches get to know each tobacco user so they can determine unique thinking patterns

and behavioral cues that drive her to use tobacco. One person may use tobacco in times o severe

stress and thereore needs to learn new coping mechanisms. Another might be a social smoker who

cant seem to stop using tobacco when she goes out or drinks with riends.

Based on this inormation, coaches then help each participant to develop an individual quitting plan

which includes strategies or developing new ways o thinking about tobacco and inormation about

how to set and prepare or a quit date.

Some telephonic programs claim to do this, yet in reality train their coaches to work o o a script.

Good counseling cannot be scripted. When looking or a tobacco cessation program, make sure to

take the time to listen to recordings o actual calls - youll be able to tell pretty quickly which ones are

scripted and which ones are tailored to the needs o the person receiving coaching support.

Medication SupportBecause a large portion o tobacco use addiction is the bodys physical dependence on nicotine,

when a person stops using nicotine, withdrawal symptoms can make it very difcult to ocus on

anything but the craving or nicotine. A specialized program should include specially trained coaches

who can provide medication support to participants who need help deciding whether nicotine

replacement therapy or prescription medications are appropriate to their quit.

Nicotine replacement therapy (NRT) works by releasing a small amount o nicotine that helps

relieve withdrawal symptoms to allow a ormer tobacco user to ocus on new thinking patterns and

behavioral strategies. Some view the use o NRT as indicating they are weak, or believe that i they

use NRT they will continue to depend on nicotine or the rest o their lives. None o these belies

are true, and its important that every tobacco user receive correct inormation and support when

considering medications.


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Capacity to Allow Multiple Quit AttemptsFinally, a qualifed program will have the capacity to allow participants to make multiple quit attempts.

Because tobacco use is a powerul addiction, smokers may need to attempt to quit several times

beore they are quit or lie - the United States Public Health Services 2008 update to Treating

Tobacco Use and Dependence qualifes tobacco dependence as a chronic disease which oten

requires repeated intervention and multiple attempts to quit.

Smokers oten struggle with a ear o ailure, so you can set your employees up or success by

oering a program that allows them to re-enroll. Youll be providing them with a saety net and

reducing any additional stress.


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Why Dont People Switch?Top Myths in Support of General WellnessDissatisaction with your current program may not be enough or you to make the switch rom a

generalized wellness oering to a specialized tobacco cessation treatment option. Why is this? There

are several common myths that can keep employers rom making the switch.

Myth #1: Our population is unreachable.Ironically, many organizations stay with a generalized wellness program because they have not seen

the kind o results theyd like to see in their smoking population. Some maintain the attitude that their

employees are dierent rom those in other organizations and unreachable. They believe that even

a comprehensive treatment option wont be able to reach and treat their tobacco users. Yet nicotine

addiction aects people o all demographics: age, race, and employment have nothing to do with the

powers o addiction. The problem is not that a particular population is unreachable, but rather that

nicotine dependence is a complex addiction that requires specialized treatment. There could be a ew

reasons that your current oering hasnt generated positive results:

You may not actually oer a specialized program. The program resources are

stretched too thin to provide an eective service. Your program could lack coaches

who have true expertise in tobacco cessation. For example, some programs use chemical

dependency counselors and portray them as having expertise when they do not. Others

use health educators who are araid to discuss medications with program participants. Both

these types o counselors may have good skills, but they may not be trained to eectively

work with the needs o tobacco users. Some programs use only one mode o interaction

and lack web components, ollow-up phone calls, supplemental materials, and proactive

outreach to ambivalent smokers.

The vendor youve chosen hasnt provided you with the right support. Whether

providing a generalized or specialized program, your vendor may not be oering you the

appropriate support in the areas o integration, implementation, and recruitment strategies.

Your organization hasnt been ully engaged. How committed is your leadership team?

How well do you communicate your tobacco cessation beneft to your employees? Determine

whether your organization is as ully engaged with the tobacco cessation initiative as is

necessary to produce positive results. Well discuss strategies or increasing employerengagement on page 12.


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Myth #2: Vendor integration is always difficult.Other employers say that adding another wellness vendor to the corporate health plan is too difcult;

they believe they will have to bear the burden o integration and dont have the resources to do so.Perhaps there is a push in your organization to consolidate vendors to minimize paper trails and

conusion. Yet vendor integration doesnt have to be a headache. Heres what you should look or in a

specialized vendor:

Proven clinical experience. Most important, make sure that the vendor you choose has built

a program based on clinical guidelines, oers a respectable list o case studies, and can prove

that they have the necessary resources to provide specialized care or your employees.

Integration experience. Find out whether the vendor has experience integrating the tobacco

cessation oering with other wellness vendors to increase the reach and quality o services

provided to your employees.

Established integration plans and processes. Maybe your organization has had trouble

integrating these vendor processes in the past, but your tobacco cessation vendor should be

able to provide you with plans and processes such as tailored messaging and the smooth

transer o participant callers to your other wellness vendors.

Detailed, transparent reporting. Make sure that the vendor is able to provide the kinds o

data you want - participant engagement, incentive results, and quit rates. Just as importantly,

the right vendor will provide you with this data in a timely manner.

Strategies to drive your desired levels o participation. Find out i they have a plan to

increase enrollment and engagement levels, and whether they can assist you with the selection

and coordination o promotional materials. They should also be able to help you implement new

policy initiatives such as going smoke-ree or helping your organization administer any premium

dierentials or incentives.

Myth #3: Specialized programs are too expensive.At ace value, specialized treatment options do tend to be a bit more expensive than those under the

umbrella o general wellness. Many who believe their populations are unreachable and who dont want

to go through the hassle o vendor integration will use cost as the main reason or not making the

switch. However, i cost is a road block to your organization selecting a specialized service, keep in

mind that it is there is a proven return on investment or evidence-based, comprehensive programs.


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Employer EngagementBest Practices for Your WorksiteThe best quality tobacco cessation program will not be as successul without 100% support and

involvement o an organizations leadership team and employee advisory board. This kind o employer

engagement can be broken down into three initiatives: oering a supportive environment in which

to quit tobacco; rewarding employee engagement in a specialized tobacco cessation program,

and communicating with your employees in a way that clearly and creatively promotes the tobacco

cessation beneft.

Offer a Supportive Environment Smoke ree or tobacco ree? Determine i a smoke-ree or tobacco-ree initiative is

best or your organization. Some organizations enorce a strict ban o all tobacco products on

company campuses. Others preer to enorce a smoke-ree policy, because it is very

observable. Enorcing a ban on smokeless tobacco products can be more difcult, given the

challenges in monitoring its use at a worksite.

Develop a plan o action. As you prepare to implement the initiative, its important to

gain the support o management and create an advisory board made up o a cross section

o employees: tobacco users, legal, management, HR, and your employee advisory board.

Get them on board and develop a plan o action.

Develop a communications plan. Think about how you will communicate with your

employees about the implementation o the tobacco-ree or smoke-ree environment,

including how the new policies will be enorced.

Establish clear policies and enorce them. Identiy how you will handle noncompliance

and communicate it regularly to your workorce. Make sure to establish a clear process that is

easily executed.

Oer easily accessible treatment option. Make sure it is available to employees prior to

and ater the transition to a smoke-ree or tobacco-ree workplace.

Keep employees inormed. Hold inormational seminars beore implementing a new policy

and keep employees up-to-date on the benefts available to them. Make sure to maintain

ongoing communication giving employees time to enroll in your organizations tobacco

cessation program.


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Reward Employee EngagementOnce youve got the process and communications approved, how do you make sure your employees

enroll and remain engaged in the program? Many employers fnd that they are able to successullyincrease participation and engagement in their tobacco cessation program when they reward the

completion o discreet activities rather than ocusing simply on enrollment or quit rates.

There are three types o incentives generally used to increase engagement in tobacco cessation

programs premium dierentials, surcharges, and rewards.

Premium dierentials. Premium dierentials are the carrot. Employees who identiy

themselves as non-tobacco users or who attempt to quit by signing up or the companys

tobacco cessation program are paid a percentage o their health plan premium contribution.

Employees who quit smoking are rewarded this sum once they have completed a distinctnumber o activities, as reported by the tobacco cessation vendor. This can range rom a $600

annually to $25 per pay check. Those who indicate tobacco use with no intention o enrolling

in a program will continue to pay the higher rates.

Surcharges. Surcharges are the stick. A surcharge program charges all tobacco users a

higher premium rate. Once the tobacco cessation vendor has reported that a tobacco user

has completed a distinct number o activities, the surcharge is removed. Those who use

tobacco will continue to pay the higher rate.

Rewards. Rewards, also called incentives, are generally based on a system o points,

rewards or git cards. Once a distinct number o activities have been completed and

reported on by the tobacco cessation vendor, the points are awarded. Many employers

who und an incentive experience higher participation and quit rates, which translates to

a higher return on investment.


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Communicate Clearly and EffectivelyYou wont be rewarding program engagement i your employees dont have the inormation they

need to get started. One o the best ways to encourage participation in your tobacco cessationprogram is to clearly, creatively, and consistently communicate the beneft to your workorce.

Create a communications plan. Many organizations dont take the time to sit down and

write down what they plan to do in the coming year. Identiy your priorities and determine

who will be tasked with each project. Drat your plan and then stick to it.

Consider your resources. It may be helpul to think about the opportunities that are

already available to you - do you have an employee intranet? A Health & Saety air where

youve never thought to mention your tobacco cessation oering? Think about ways to

leverage the tools and opportunities already in existence.

Develop compelling messaging. Once you know how you will communicate your beneft,

determine what you will say about it. Develop compelling messaging that clearly explains

enrollment details and any incentives you may be oering. Do you have any special

populations in your workorce? Tailor communications to reach out to smokers who are

pregnant, have chronic conditions, or who are worried about weight gain. Dedicated

vendors can provide you with communication templates or email, intranets, home mailers,

and e-newsletters, and can even provide you with ideas or specialized messaging.

Creatively promote the beneft. Think beyond your typical promotional materials like

emails and posters. Ask yoursel whether your employees actually utilize your organizations

intranet i they do not, it may be time to try think outside the box. Hang a sheet o paper inyour break room and encourage employees to write down reasons to be tobacco-ree.

Organize events like a walk-to-quit, and encourage all employees smokers and

nonsmokers alike to come together or the cause.


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ConclusionTobacco cessation is still the most cost-eective beneft you can oer your adult employees youll

save in costs ranging rom medical care to productivity losses to cleaning ees. As many ormer

smokers taken on healthier liestyles, your investment in cessation may urther savings as your

employees increase their physical activity and improve their nutrition.

But you will only see the true rewards o investing in a tobacco cessation program i it generates

positive outcomes or your organization.

The right vendor will provide support on two ronts not only will they oer your employees the right

tools to change the way they think about tobacco and develop strategies to live lie without tobacco,

they will provide you with the right tools to recruit the employees who need the program the most.

Choose an experienced vendor with a specialized program that addresses the unique challenges o

nicotine addiction and the majority o your work will be done.


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About UsAlere Wellbeing

Alere Wellbeing (ormerly Free & Clear) drives sustained health behavior change by connecting individuals

with knowledge and inormation, and then empowering them to act on that knowledge to improve their

own health and wellbeing. Alere Wellbeings evidence-based Quit For Lie and Mind & Body programs

address modifable health risks that contribute to chronic disease: tobacco use, poor nutrition, physical

inactivity, and stress. Current clients include 27 state governments and more than 600 health plans and

employers, 63 o which are in the Fortune 500. Alere Wellbeing is known and respected or its pay-or-

perormance business model, intense ocus on scalable service quality, dedicated account management,

continuous program improvement, and transparent reporting o measurable outcomes at the individual

participant and aggregate population level. Alere Wellbeing has contributed to more than 100 publishedresearch studies and maintains collaboration with the American Cancer Society and an active research

program unded by the Centers or Disease Control, American Legacy Foundation, and the National

Institutes o Health. More inormation about Alere Wellbeing can be ound at www.alerewellbeing.com.

The Quit For Life

ProgramOered in collaboration with the American Cancer Society, the Quit For Lie Program has been the

nations leading evidence-based tobacco cessation program or more than 25 years. The Quit For Lie

Program employs an evidence-based combination o physical, psychological and behavioral strategies

to enable participants to take responsibility or and overcome their addiction to tobacco use.


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