Adopting tobacco cessation and prevention programs in the workplace can decrease medical costs, lead to improved productivity, and most importantly, improve employee health.
How prevalent is smoking in the workplace?
19.6% of currently working adults are cigarette smokers.1 Prevalence of smoking is highest in mining workers, food service workers, construction workers, and service-related occupation groups. 1
In the United States (U.S.), an estimated 3.6 million, or 3.5% of all workers, report smokeless tobacco use. The prevalence of smokeless tobacco use is highest for farm workers (10.5%) and blue-collar workers (7.3%), whereas it tends to be lower for service workers (2.4%) and white-collar workers (2.0%).2
What is the cost of employee tobacco use?
Smoking costs employers an estimated $3,391 per smoker per year, comprised of $1,623 in direct medical expenditures and $1,768 in lost productivity. 2 During 2000–2004, cigarette smoking was estimated to be responsible for $193 billion in annual health-related economic losses in the U.S. (nearly $96 billion in direct medical costs and an additional $97 billion in lost productivity).3
Secondhand smoke also costs employers in the form of employee health concerns. A 2007 study found that environmental tobacco smoke in the workplace is a significant risk factor for lung cancer.4 Specifically, there was a 24% increase in lung cancer risk among workers exposed to environmental tobacco smoke.4
What are the benefits of a tobacco-free workplace?
1. Protect employee health
Implementing a tobacco-free workplace can reduce the risk of lung cancer, heart disease, heart attacks, and upper respiratory infections in employees.5 It can also reduce the incidence of sensory irritations and respiratory infections caused by secondhand smoke.6
A tobacco-free workplace can also reduce smokeless tobacco use. Contrary to concerns that smokers may “compensate” for a workplace smoking ban through increased use of smokeless tobacco, results from a 1997 study showed a reduction in smokeless tobacco use among employees at smoke-free workplaces.7
2. Lower costs
Implementing a tobacco-free workplace can lower employer health costs and increase worker productivity. In a cost-effectiveness comparison using simulated data, a statewide workplace smoking ban was nearly nine times more cost-effective per successful quitter generated than a free nicotine replacement therapy (NRT) program. One year’s worth of simulated data indicated that a free NRT program would generate 18,500 quitters at a cost of $7020 per quitter, compared to a statewide workplace smoking ban, which would generate 10,400 quitters at a cost of $799 per quitter.8
3. Increase productivity
A tobacco-free workplace can increase worker productivity. Employees who take four 10-minute breaks a day to smoke actually work one month less per year than workers who do not take smoking breaks.9
Smokers were also found to be less productive than non-smoking employees due to absenteeism and presenteeism (attending work while sick). In a 2006 study, researchers found the mean cost of days missed per employee per year to be $1156 for nonsmokers and $1811 for smokers. The mean cost of presenteeism for 11 measured health conditions per employee per year was $1146 for nonsmokers, compared to $2619 for smokers.10
Research has also shown that former smokers show higher levels of work productivity than current smokers. In a 2001 study, researchers found former smokers showed higher objective productivity scores in seven out of ten categories compared to current smokers.6
4. Reduce absenteeism
Smokers are more likely to suffer a disability and are more likely to miss work due to illness.10
In 2001, researchers found that current smokers in the U.S. missed 6.16 days of work in a year, compared with 4.53 days for former smokers and 3.86 days for nonsmokers.6
5. Reduce liability
Establishing a tobacco-free workplace can also reduce an employer’s liability. An employee could file a worker’s compensation claim against an employer for injury or illness attributable to secondhand smoke at work, potentially increasing an employer’s workers’ compensation premiums.11
If an employee has a disability, such as asthma, which is exacerbated by secondhand smoke, the employee could file a disability discrimination claim against the employer.11
An employee could also file a claim that the employer failed to provide a safe workplace.11
How can employers implement a tobacco-free workplace?
- Use the company’s health plan to encourage tobacco cessation.
Using the company’s health plan to promote a tobacco-free workplace is a cost-effective solution. Tobacco cessation is more cost-effective than most other common and insurance-covered disease prevention interventions, such as treatment of hypertension and high cholesterol. 13
The most highly recommended treatment option for tobacco cessation is healthcare provider support along with medication and counseling. 12 Employers should take a long-term approach to smoking cessation and structure their benefits to provide for multiple quit attempts. Employers should also communicate to employees the cessation benefits that are available.12
- Promote the Maryland Quit Line.
Employers can promote quit lines, which are another effective way to promote smoking cessation. Only about 7% of smokers remain smoke-free one year after quitting on their own. However, the one-year abstinence rate for smokers who use quit lines increases to 30%.14 The Maryland Quit Line offers the following free services:
- Telephone counseling
- Nicotine replacement therapy
- Web-based services
- Resources for health care providers
- Implement a policy restricting smoking in the workplace.
Research shows workplace smoking ordinances increased smoking cessation among employed smokers. In a 2005 study, employees whose workplaces restricted smoking were 1.9 times more likely to have quit smoking than employees whose workplaces did not restrict smoking. Results show that a 100% smoke-free policy is more effective than a partial ban in influencing the number of cigarettes consumed daily and enhances the chances of someone quitting successfully. 15
A 2002 meta-analysis of the effects of smoke-free workplaces found a 29% relative reduction in cigarettes smoked per day due to lower smoking prevalence and lower consumption per continuing smoker. By comparison, a 73% increase in the price of cigarettes would be required to obtain the same 29% reduction resulting from smoke-free workplaces.16
Case studies of tobacco-free workplaces
- Panasonic Corporation of North America
In July 2007, Panasonic banned smoking on its North American headquarters in Secaucus, New Jersey. To help employees abide by the smoking ban, Panasonic implemented a tobacco cessation program through Free & Clear. Panasonic made changes to employee health plans, including 100% coverage for tobacco cessation medications. After implementation of the program, Panasonic received a 96.2% employee satisfaction rating regarding the new plan. 18
- Carpenter’s Trust Western Washington
Under the Carpenter’s Health and Security Trust of Western Washington (CTWW), Free & Clear implemented a program for tobacco users in the trust, wherein participants would receive either one or five telephone counseling sessions. One year after registration, 27.7% of CTWW employees had quit smoking. The estimated savings provided an annual return on investment of over 27%. 18
- University of Wisconsin Hospital and Clinics
The University of Wisconsin Hospital and Clinics (UWHC) partnered with The University of Wisconsin Center for Tobacco Research and Intervention to increase the number of UWHC employee who attempted to quit smoking over a three-year period. UWHC offered free medications and counseling and emphasized communication with employees. Three months into the implementation of the program, 233 employees enrolled and made a quit attempt. 12
Free & Clear, Inc is a U.S. commercial treatment program that provides employers with resources to help with tobacco cessation.
1. Centers for Disease Control and Prevention. (2011). Current cigarette smoking prevalence among working adults - United States, 2004 – 2010. Retrieved August 9, 2012 from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6038a2.htm
2. Dietz, N., Lee, D., Fleming, L., Leblanc, W., McCollister, K., Arheart, K., & ... Caban-Martinez, A. (2011). Trends in smokeless tobacco use in the U.S. workforce: 1987-2005. Tobacco Induced Diseases, 9(1): 6.
3. Musich, S; Napier,D; Edingthon, D.W. (2001). The association of health risks with workers' compensation costs. Journal of Occupational and Environmental Medicine, 43(6): 534-541.
4. Centers for Disease Control and Prevention. (2008). Smoking-attributable mortality, years of potential life lost, and productivity losses—United States, 2000–2004. Morbidity and Mortality Weekly Report, 57(45):1226–1228.
5. Stayner, L., Bena, J., Sasco, A. J., Smith, R., Steenland, K., Kreuzer, M., & Straif, K. (2007). Lung cancer risk and workplace exposure to environmental tobacco smoke. American Journal of Public Health, 97(3), 545-551. doi:10.2105/AJPH.2004.061275
6. Halpern, M.T.; Shikiar, R; Rentz, A.M., & Khan, Z.M. (2001). Impact of smoking status on workplace absenteeism and productivity. Tobacco Control 10(3): 233-238.
7. Glasgow, R., Cummings, K., & Hyland, A. (1997). Relationship of worksite smoking policy to changes in employee tobacco use: findings from COMMIT. Community Intervention Trial for Smoking Cessation. Tobacco Control, 6(2): 44-S48.
7. Eisner, M.D., Smith, A.K., & Blanc, P.D. (1998). Bartenders' respiratory health after establishment of smoke-free bars and taverns. JAMA 280(22):1909-1914.
8. Ong, M. K., & Glantz, S. A. (2005). Free nicotine replacement therapy programs vs implementing smoke-free workplaces: A cost-effectiveness comparison. American Journal of Public Health, 95(6), 969-975.
9. Bunn, W. B., Stave, G. M., Downs, K. E., Alvir, J. J., & Dirani, R. (2006). Effect of smoking on productivity loss. Journal of Occupational & Environmental Medicine, 48(10), 1099-1108.
10. Center for Prevention and Health Services, Center for Disease Control and Prevention. (2003). Reducing the Burden of Smoking on Employee Health and Productivity, 1(5).
11. Zellers, L., Thomas, M. A., & Ashe, M. (2007). Legal risks to employers who allow smoking in the workplace. American Journal of Public Health, 97(8), 1376-1382.
12. UW Center for Tobacco Research and Intervention. (2007). Strategies for a tobacco-free workplace in Wisconsin.
13. Fiore, M.C., Bailey, W.C., & Cohen, S.J. (2000). Treating tobacco use and dependence: Clinical practice guideline. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, 2000.
14. Fiore, M. C., Jaen, C. R., & Baker, T.B. (2008). A clinical practice guideline for treating tobacco use and dependence: 2008 update. American Journal of Preventive Medicine, 35(2), 158-176.
15. Bauer, J. E., Hyland, A., Li, Q., Steger, C., & Cummings, K. (2005). A longitudinal assessment of the impact of smoke-free worksite policies on tobacco use. American Journal of Public Health, 95(6), 1024-1029.
16. Fichtenberg, C.M., & Glantz, S.A. (2002). Effect of smoke-free workplaces on smoking behaviour: Systematic review. British Medical Journal; 325, 188-191.
17. National Business Group on Health, et al. (2008). Panasonic corporation of America case study. Retrieved July 31, 2012 from http://www.alerewellbeing.com/research-center/research-library/case-stud...
18. Free & Clear, Inc. n.d. Carpenter’s Trust Western Washington case study. Retrieved July 31, 2012 from http://www.alerewellbeing.com/research-center/research-library/case-stud...