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Smoking And Tobacco Use In The Workplace

Brevard Tobacco Initiative



Brevard County, Fla. Tobacco use remains the single largest preventable cause of death in the United States. Smoking is responsible for more than 480,000 deaths per year, which costs the country a staggering $289 billion in healthcare and lost productivity. Although smoking rates declined from approximately 42 percent in 1965 to 18 percent in 2013, roughly 42 million U.S. adults still smoke. In the workplace, smoking prevalence varies by type of worker, industry type and occupation. Overall, “blue-collar” workers smoke significantly more than “white-collar” workers.  Other high-risk populations include African-Americans, individuals with mental disorders, lower education or who live below the poverty level, the disabled and LGBT men and women. While smoke-free policies have dramatically decreased, exposure to second-hand smoke (SHS), one in five non-smoking working adults are still exposed to SHS on at least one day a week.  Indeed, SHS exposure causes more than 41,000 deaths annually among non-smokers.  E-cigarettes are relatively new products that have not been well-studied—neither the harms nor the role of e-cigarettes as a cessation aid.  Although e-cigarettes are increasingly included in smoke-free policies, approximately one in three current smokers report using e-cigarettes.


The Case for Comprehensive Tobacco Control

Tobacco use not only affects the health of employees, it also has an adverse impact on medical costs and productivity. Various research studies have shown that:

  • Smokers take on average 2-4 more sick days each year than nonsmokers,
  • The annual cost to employ a smoker is on average $6,000 more than employing a non-smoker,
  • Lost productivity costs are about $4,430 per year for current smokers compared to $2,623 per year for non-smokers,
  • SHS increases the risk of heart disease and lung cancer up to 30 percent, and non-smoking employees exposed to SHS have higher medical costs due to smoke-related illnesses.


Implementing comprehensive tobacco policies in the workplace can rapidly reduce the risk of cardiovascular disease, gradually reduce the additional risk for cancers, improve worker productivity and therefore reduce the direct and indirect medical costs of tobacco use.


Proven Workplace Strategies

Three strategies are recommended that are supported by rigorous scientific evidence: 1. Implement tobacco-free policies 2. Improve access to the Quitline for tobacco users 3. Offer proven tobacco treatment benefits through your health plan with no co-pays.


Tobacco Control in the Workplace

Furthermore, the U.S. Department of Labor recently provided guidance to employers to define adequate tobacco cessation coverage, which comprises offering the following services without any cost sharing: (1) screening for tobacco use and; (2) offering two cessation attempts each year for those who smoke. Coverage for a cessation attempt is defined as four tobacco counseling sessions of at least 10 minutes each (telephone, individual or group), and all FDA approved tobacco cessation medications for a 90-day treatment regimen when prescribed by a healthcare provider without prior authorization.  Research-Tested Intervention Programs Companies and their health insurance plans are encouraged to adopt research-tested intervention programs. The Community Guide and U.S. Preventive Services Task Force provide the most up-to-date information about effective programs, and evidence is updated every few years based on the latest science.  Current evidence indicates that mobile-phone interventions, quitlines and reducing out-of-pocket costs for evidence-based cessation treatments are effective ways to reduce tobacco use in the workplace. In contrast, internet-only cessation interventions, and the use of competitions and incentives on their own are not effective.


Recommendations to Address E-Cigarettes

E-cigarette use is increasing, however, the U.S. Food and Drug Administration recently began to regulate e-cigarettes, however it is not an approved nicotine replacement product for tobacco cessation. While the specific toxicity of e-cigarettes may vary by device, growing scientific evidence indicates that frequent use of e-cigarettes could have some adverse health effects. AHA endorses recent guidance to employers to integrate e-cigarettes into tobacco worksite policy as follows: 1. Include e-cigarettes in tobacco-free policies and ban e-cigarette use in smoke-free work areas, 2. Screen both for tobacco and e-cigarette use to tailor wellness programs and worksite policies optimally, 3. Make e-cigarettes users eligible for comprehensive tobacco cessation services.


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