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Research & Evidence

The qualifying studies provided sufficient evidence that smokefree policies reduce tobacco use among workers when implemented in worksites or by communities. Finally, a systematic economic review identified four studies that, overall, demonstrated economic benefits from a smokefree workplace policy.
Smokefree Policies to Reduce Tobacco Use: A Systematic Review
David P. Hopkins, MD, MPH, Sima Razi, MPH, Kimberly D. Leeks, PhD, MPH, Geetika Priya Kalra, MPA, Sajal K. Chattopadhyay, PhD, Robin E. Soler, PhD
American Journal of Preventive Medicine

2014

"IBI Chronic Disease Profile: Cancer." Integrated Benefits Institute, March 2014.

A growing recognition of the impact of workforce health on business performance has increased interest in workplace interventions and management strategies for chronic health conditions. In support of this broadened value proposition, IBI is drawing on a variety of information sources to publish a series of “disease profiles” for employers and their benefits partners. The profiles highlight the prevalence, full costs, co-morbidities and intervention approaches for key chronic health conditions. This month we profile cancer in the workforce.

"Best Practices for Comprehensive Tobacco Control Programs ." Centers for Disease Control and Prevention, 201.

Tobacco use is the single most preventable cause of disease, disability, and death in the United States. Nearly one-half million Americans still die prematurely from tobacco use each year, and more than 16 million Americans suffer from a disease caused by smoking. Despite these risks, approximately 42.1 million U.S. adults currently smoke cigarettes. And the harmful effects of smoking do not end with the smoker. Secondhand smoke exposure causes serious disease and death, and even brief exposure can be harmful to health. Each year, primarily because of exposure to secondhand smoke, an estimated 7,330 nonsmoking Americans die of lung cancer and more than 33,900 die of heart disease. Coupled with this enormous health toll is the significant economic burden. Economic costs attributable to smoking and exposure to secondhand smoke now approach $300 billion annually.

"Coverage for Tobacco Use Cessation Treatments." Centers for Disease Control and Prevention, 2014.

This updated 2014 document provides an overview of the evidence base for tobacco cessation insurance coverage, best practices for designing cessation coverage, and the current status of cessation coverage.

Workplace wellness is a $6 billion dollar industry in the United States. Employers offer the programs to improve the health and well-being of their employees, increase their productivity, reduce their risk of costly chronic diseases, and improve control of chronic conditions. In 2012, half of all employers with at least 50 employees offered programs, and nearly half of employers without a program said they intend to introduce one.

U.S. Department of Health and Human Services. "The Health Consequences of Smoking—50 Years of Progress. A Report of the Surgeon General. ." U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.

This comprehensive report chronicles the devastating consequences of 50 years of tobacco use in the United States. It updates data on the numerous health effects resulting from smoking and exposure to secondhand smoke, and details public health trends, both favorable and unfavorable, in tobacco use. This report marks the steady progress achieved in reducing the prevalence of smoking and validates tobacco control strategies that have consistently proven to be effective. It also examines strategies with the potential to eradicate the death and disease caused by the tobacco epidemic at long last, and identifies specific measures that should be taken immediately to move smoking off its decades-old number one spot as the largest single cause of preventable death and disease for the citizens of the United States. Finally, the report documents that effective interventions are available and calls for their full implementation.

2013

Lankford, Tina; Jason Lang, Brian Bowden, and William Baun. "Workplace Health: Engaging Business Leaders to Combat Obesity." Journal of Law, Medicine & Ethics, December 1, 2013.

Recognizing the adverse impact of obesity on employee productivity and health, many businesses have invested resources in worksite strategies to increase physical activity and improve the diets of their employees. Employers play a pivotal role in creating health-supportive environments for their employees as well as the community at large. Employers that contribute to a healthier workforce have the potential to reduce their out-of-pocket health care costs and improve productivity within their workforce. Further, through community engagement, employers can foster the improved health and stability of their future workforce

Fabius, Raymod, MD; R. Dixon Thayer, BA, Doris L. Konicki, MHS, Charles M. Yarborough, MD, Kent W. Peterson, MD; Fikry Isaac, MD; Ronald R. Loeppke, MD, MPH; Barry S. Eisenberg, MA; and Marianne Dreger, MA. "The Link Between Workforce Health and Safety and the Health of the Bottom Line: Tracking Market Performance of Companies That Nurture a “Culture of Health”." Journal of Occupational and Environmental Medicine, September 9, 2013.

A growing body of evidence supports the concept that focusing on the health and safety of a workforce is good business. Engaging in a comprehensive effort to promote wellness, reduce the health risks of a workforce, and mitigate the complications of chronic illness within these populations can produce remarkable effects on health care costs, productivity, and performance. The literature is replete with examples demonstrating that the health of employees impacts their performance and productivity. In addition, for the majority of the employers who pay for the cost of health care provided to their employees, there is a direct impact on the bottom line.

Henke, Rachel, PhD; Ron Z. Goetzel, PhD; Janice McHugh;Deborah Gorhan; Malinda Reynolds; Jaclyn Davenport; Kate Rasmussen; and Fikry Isaac, MD. "Employers' Role in Cancer Prevention and Treatment—Developing Success Metrics for Use by the CEO Roundtable on Cancer." Population Health Management, August 13, 2013.

As evidence accumulates on the risk factors for cancer, it is becoming clearer that employers can play a significant role in the fight against the disease by creating a workplace conducive to lowering health risks. The CEO Roundtable on Cancer’s CEO Cancer Gold Standard Program defines what companies can do to prevent cancer, detect it early, and ensure access to the best available treatments for those who are afflicted with the disease. This article describes how Johnson & Johnson incorporated the Cancer Gold Standard Program into its existing health promotion initiatives.

This commentary is in response to the March 5, 2013 Health Affairs article, "Wellness Incentives in the Workplace: Cost Savings through Cost Shifting to Unhealthy Lifestyles."  In that article, Jill Horwitz and coauthors express concerns about new rules governing workplace health promotion (wellness) programs due to take effect in 2014 as part of the Patient Protection and Affordable Care Act of 2011, Public Law 111-148 (“ACA”). 

In this post, I explain how well-designed wellness programs can benefit both employers and employees, and I offer some suggestions to ensure that such programs are both effective and fair. 

Lee, Joseph G L, Leah M Ranney, Adam O Goldstein. "Cigarette butts near building entrances: what is the impact of smoke-free college campus policies?." BMJ Journals, February 15, 2013.

Abstract

Background Indoor and outdoor tobacco-free campus policies for schools, hospitals and universities are increasingly being adopted. Yet, little direct evidence exists on the impact of tobacco-free campuses on tobacco outcomes.

Objectives To identify differences in cigarettes smoked at main campus building entrances by campus policy strength.

Methods Researchers collected cigarette butts (n=3427) at main building entrances (n=67) at baseline and follow-up on 19 community college campuses stratified by strength of campus outdoor tobacco policy (none, perimeter/designated area, 100% tobacco free). Outcome measures included the number of butts per day at building entrances averaged to create a campus score. Analysis of variance techniques examined differences in scores by the strength of campuses' outdoor tobacco policy.

Results One hundred per cent tobacco-free community college campuses had significantly fewer cigarette butts at doors than campuses with no outdoor restrictions. Butts on community college campuses with partial policies were not statistically different from campuses with no policy or campuses with a 100% tobacco-free policy but indicated that a dose–response relationship may exist.

Conclusions This study provides some of the first evidence on the impact of 100% tobacco-free outdoor policies on college campuses using an objective and reproducible measure. Such policies likely provide a more healthful environment for students, staff, faculty and visitors.

2012

Recent research suggests that obesity and excess weight can play a prominent role in the incidence and progression of various cancers.

Tobacco is the leading cause of preventable and premature death, killing an estimated 443,000 Americans each year. Cigarette smoking costs the nation $96 billion in direct medical costs and $97 billion in lost productivity annually. In addition to the billions in medical costs and lost productivity, tobacco is enacting a heavy toll on young people.

Each day in the United States, over 3,800 young people under 18 years of age smoke their first cigarette, and over 1,000 youth under age 18 become daily cigarette smokers. The vast majority of Americans who begin daily smoking during adolescence are addicted to nicotine by young adulthood. Despite the well-known health risks, youth and adult smoking rates that had been dropping for many years have stalled. When this Administration took office, we decided that if these numbers were not changing, we had to do something. We accelerated our efforts to fight tobacco by helping Americans stop smoking and protecting young people from starting to smoke.

2011

"Position Statement on Tobacco on College and University Campuses." American College Health Association, November 2011.

The American College Health Association (ACHA) acknowledges and supports the findings of the Surgeon General that tobacco use in any form, active and/or passive, is a significant health hazard...ACHA joins with other professional health associations in promoting tobacco-free environments.

Smith Carls,Ginger, PhD, Ron Z. Goetzel, PhD, Rachel Mosher Henke, PhD, Jennifer Bruno, BS, Fikry Isaac, MD, and Janice McHugh, DBA, RN, COHN-S. "The Impact of Weight Gain or Loss on Health Care Costs for Employees at the Johnson & Johnson Family of Companies." Journal of Occupational and Environmental Medicine, January 2011.

Objective: To quantify the impact of weight gain or weight loss on health care costs.

Conclusions: Preventing weight gain through effective employee health promotion programs is likely to result in cost savings for employers.

2010

Berry, Leonard L.; Ann M. Mirabito and William B. Baun. "What’s The Hard Return on Employee Wellness Programs?." Harvard Business Review, December 1, 2010.

The ROI data will surprise you, and the softer evidence may inspire you.

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