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TOBACCO-FREE
LIVING: What Works at Work!
For more information or consultation, 519-883-2287
www.projecthealth.ca
Copyright Acknowledgment
Written permission is required if any adaptations or changes are made to this resource. No part of this
resource may be used or reproduced for commercial purposes or to generate monetary profits. Copies of this
resource, in its entirety, may be created for non-commercial use provided the source is fully acknowledged
©Region of Waterloo Public Health, August 2013
Acknowledgements
If you are adapting or reprinting with permission, please include the following statement: ____________ would like to thank The Regional Municipality of Waterloo, Public Health Department for allowing us to adapt their resource “_____________”.
Resource prepared by:
Stephanie Watson Public Health Nurse Julia Pilliar Public Health Planner Sandy Keller Public Health Planner
With contributions from the following staff:
Gretchen Sangster RN Public Health Nurse Katie McDonald Public Health Planner
1.0 INTRODUCTION 6
ABOUT THIS TOOLKIT 7
‘TOBACCO-FREE’ INSTEAD OF ‘SMOKE-FREE’ 7
COMPREHENSIVE WORKPLACE HEALTH PROMOTION 8
2.0 BACKGROUND 10
MAKING THE CASE FOR TOBACCO-FREE LIVING 11
THE SMOKE-FREE ONTARIO ACT 13
HEALTH CONSEQUENCES OF TOBACCO USE 15
ALL FORMS OF TOBACCO ARE HARMFUL 16
NOT ONLY TOBACCO USERS ARE AT RISK 17
TOBACCO USE RATES 18
WATERLOO REGION 20
DOLLARS AND CENTS 23
3.0 GETTING STARTED 29
CREATING AN EFFECTIVE COMPREHENSIVE TOBACCO-FREE LIVING STRATEGY 30
STEP 1 GAIN MANAGEMENT AND ORGANIZATIONAL SUPPORT 31
STEP 2 FORM A WELLNESS COMMITTEE 32
STEP 3A ASSESS NEEDS AND INTERESTS 36
STEP 3B ASSEMBLE A WORKPLACE TOBACCO CONTROL SUB-COMMITTEE 41
STEP 4 DEVELOP A TOBACCO-FREE LIVING PROGRAM PLAN 42
STEP 5 DEVELOP THE EVALUATION PLAN 47
STEP 6 CHECK-IN WITH MANAGEMENT 49
STEP 7 IMPLEMENT THE PLAN 49
STEP 8 EVALUATE AND UPDATE THE STRATEGY 51
4.0 STRATEGIES 56
TOBACCO-FREE LIVING STRATEGIES AT A GLANCE 57
4.1 AWARENESS RAISING 60
INCREASE GENERAL KNOWLEDGE 61
PROMOTE WORKPLACE TOBACCO-FREE LIVING PROGRAMMING 63
PROMOTE TOBACCO CESSATION RESOURCES IN THE COMMUNITY 63
COMMUNICATE DETAILS OF BENEFITS COVERAGE 65
AWARENESS RAISING METHODS 66
BULLETIN BOARDS AND POSTERS 67
DISPLAYS 67
Ta
ble
of C
on
ten
ts
HEALTH FAIRS 68
EMAILS 68
NEWSLETTERS 69
PAMPHLETS AND BROCHURES 70
EVENTS 71
MOBILE HEALTH TECHNOLOGY 71
POINT-OF-DECISION INFORMATION 73
4.2 SKILL BUILDING 78
SELF HELP RESOURCES 79
TELEPHONE COUNSELING 80
WEB- AND COMPUTER-BASED PROGRAMMING 81
CONTESTS, CHALLENGES, AND INCENTIVES 82
PLEDGE CARDS 86
HEALTH SCREENING AND HEALTH RISK ASSESSMENTS 87
SELF-MONITORING TOOLS 89
LUNCH AND LEARNS 89
HEALTH FAIRS 90
GOAL-SETTING AND ACTIVITY PLANS 91
4.3 SUPPORTIVE ENVIRONMENT 99
4.3.1 ORGANIZATIONAL CULTURE 103
ORGANIZATIONAL FACTORS THAT AFFECT TOBACCO USE 104
WORK SCHEDULES 104
JOB STRESS 105
SOCIAL NORMS 105
STRATEGIES TO PROMOTE A POSITIVE ORGANIZATIONAL C ULTURE 107
COWORKER SUPPORT 107
SUPPORTIVE MANAGEMENT PRACTICES 107
REWARDS AND RECOGNITION 109
4.3.2 PHYSICAL WORK ENVIRONMENT 112
HAZARDS 113
PLACES FOR TOBACCO USE 114
CONSIDERATIONS FOR SPECIFIC TYPES OF EMPLOYMENT 115
TRANSIENT WORK 115
CONSTRUCTION AND OUTDOOR WORK 115
TRANSPORTATION 116
SERVICE AND HOSPITALITY 117
4.3.3 EXTENDED HEALTH BENEFITS FOR TOBACCO-FREE LIVING 121
COMPREHENSIVE BENEFITS PLANS 122
NICOTINE REPLACEMENT THERAPY (NRT) 124
BUPROPION HYDROCHLORIDE (BRAND NAME ZYBAN) 125
VARENICLINE TARTRATE (BRAND NAME CHAMPIX) 125
INDIVIDUAL COUNSELING 125
COVERAGE VARIANCE 127
WHAT TO INCLUDE IN A GROUP BENEFITS PLAN 128
4.3.4 COMPREHENSIVE CESSATION PROGRAMMING 131
SMOKING CESSATION CLINICAL PRACTICE GUIDELINES 133
LEVELS OF SUPPORT THE WORKPLACE MAY PROVIDE 134
COMPREHENSIVE WORKPLACE CESSATION PROGRAMMING 138
4.4 POLICY DEVELOPMENT 141
BENEFITS OF A TOBACCO-FREE POLICY IN THE WORKPLACE 142
POLICY DEVELOPMENT STEPS 143
PLAN FOR THE POLICY 143
IDENTIFY, DESCRIBE, AND ANALYZE THE PROBLEM 144
ASSESS WORKPLACE SUPPORT, CAPACITY, AND 145
READINESS
DEVELOP GOALS AND OBJECTIVES 146
BUILD SUPPORT FOR THE POLICY 147
WRITE AND REVISE THE POLICY 148
POLICY OPTIONS 150
POLICY EXAMPLES 154
OTHER CONSIDERATIONS 157
IMPLEMENT THE POLICY 158
ENFORCE THE POLICY 158
EVALUATE AND MAINTAIN THE POLICY 159
A TOBACCO USE POLICY SHOULD... 162
FREQUENTLY ASKED QUESTIONS 164
APPENDIX 168
6 Project Health – Tobacco-Free Living: What Works at Work!
INTRODUCTION
1.0 In
trod
uctio
n
7 Project Health – Comprehensive Strategies to Promote Tobacco-Free Living
About This Toolkit
This toolkit is intended to assist employers in taking a comprehensive approach
to promoting health, specifically tobacco-free living in the workplace. It
incorporates information on the health effects of tobacco use and exposure to
second-hand smoke, outlines the rates of tobacco use across Canada and within
Waterloo Region, and presents the latest research on the complex issues
workplaces experience while trying to promote tobacco-free living. The benefits
to organizations who address tobacco use are highlighted and information is
provided about the Smoke-Free Ontario Act, including employee rights and
employer responsibilities. A wide range of strategies are presented to raise
awareness, build skills, create supportive environments, and develop policies
within the workplace that both support employees to quit or reduce tobacco use
and protect the health of all employees and guests through exposure to second-
hand smoke.
‘Tobacco-Free’ Instead of ‘Smoke-Free’
While cigarette smoking is the most commonly used and most visible form of
tobacco, this toolkit refers to ‘tobacco-use’ instead of ‘smoking’ where
appropriate to be inclusive of all tobacco products available in Ontario that
workers might use. Please see the Tobacco Products Factsheet in the Appendix
for a description of different tobacco products.
Project Health staff are available to provide consultation to help workplaces
assess employee needs and interests, implement effective and sustainable
programming, and develop healthy policies to promote tobacco-free living and
protect all employees from the health hazards of tobacco.
For more information about Project Health, or to request a consultation, refer to
the Project Health website, www.projecthealth.ca, or contact us directly at
[email protected] or 519-883-2287.
8 Project Health – Tobacco-Free Living: What Works at Work!
Occupational Health
& Safety
Voluntary Health
Practices
Organizational Change
Comprehensive Workplace Health Promotion
There are three critical areas in organizations that influence employee health
and health behaviours.
Occupational Health and Safety
The first area, traditional health
and safety initiatives, protect
employees from physical harm
or exposure to harmful substances
with the goal of reducing work related
injury, illness and disability. While
occupational health and safety initiatives
are important, on their own these initiatives
are not enough to create a healthy work
environment.1
Voluntary Health Practices
The second area of comprehensive workplace health promotion is voluntary
health practices (i.e., smoke-free living, physical activity, healthy eating, etc.).
Workplace health promotion strategies often focus on changing voluntary
health practices of individuals by running educational and skill building
programs. The programs are often targeted at individual behaviour change;
however, they are less likely to be effective compared to strategies that also
target organizational factors that impact personal health practices.
Organizational Change
When planning workplace health promotion efforts, it is important to make
improvements to organizational culture either before or in conjunction with
voluntary health promotion activities.
A supportive organization means the workplace promotes physical and mental
health and well-being. There are many areas that workplaces can target to
improve the health outcomes of employees such as enhancing social support,
ensuring a job effort-reward balance, and improving job control, work structure,
communication strategies, organizational change processes and management
style.2
9 Project Health – Comprehensive Strategies to Promote Tobacco-Free Living
In a supportive workplace, employees have adequate job training, a sense of
fairness and respect on the job, work-life balance, some control over how their
work is completed and are rewarded adequately for their efforts. In an ideal
workplace, efforts are made to manage and prevent workplace conflict and help
is available to assist employees in times of distress.2
A negative organizational culture can limit the effectiveness of workplace health
promotion efforts. Issues related to organizational culture that may affect
employee health should be addressed to enhance the effectiveness of a
comprehensive workplace tobacco-free living strategy. Refer to the section
Supportive Environment for suggestions on improving organizational culture to
support your wellness efforts.
References 1 Bachmann K. Health promotion programs at work: A frivolous cost or a sound investment? Conference
Board of Canada; 2002. 2 Canadian Mental Health Association. Comprehensive workplace health promotion – Affecting mental
health in workplace [Internet]. 2010 Dec 22 [cited 2012 Jan 23]. Available from: http://wmhp.cmhaontario.ca/comprehensive-workplace-health-promotion-affecting-mental-health-in-the-workplace
1 Project Health – Tobacco-Free Living: What Works at Work!
BACKGROUND Understanding the Issue of Tobacco Use
2.0 B
ack
gro
un
d
11 Project Health – Tobacco-Free Living: What Works at Work!
Making the Case for Tobacco-Free Living at Work
In today`s economy, many workplaces are identifying the benefits of promoting
wellness in the workplace. Helping employees be tobacco-free is one of the best
things employers can do to improve worker health and it can improve the
company’s bottom line.
The workplace is an ideal setting to encourage tobacco free living because many
people spend a large portion of their waking time at work, where accessing
information and supports may be more convenient – and therefore more likely
to be used. Workplaces can provide a supportive social environment that is
helpful for quitting, and workplaces with restrictive smoking policies encourage
smokers to cut down or quit and help those who are already smoke-free to
remain so.1
Smoking has been reported to cost the Ontario
economy $2.6 billion in lost productivity each
year.2 Research into the return on investment
(ROI) of smoking cessation programming in
workplaces has shown workplaces to experience a
ROI of at least $3 and up to $10 (USD) for each $1
spent.3 Workplaces have been reported to
experience net financial savings (net profit) three
or four years after cessation program
implementation in the workplace, with ROIs
estimated at 39 per cent to 60 per cent within ten
years of program implementation.4 Workplace
cessation programs are identified by the World Bank as economical
interventions, being relatively low cost, and producing financial returns over the
long-term that far outweigh their costs.5 Although opponents have voiced
concern that smoking bans may damage business, research indicates this to be
false.5 Furthermore, the majority of smokers and non-smokers prefer smoke-
free work environments, and smoke-free workplaces improve company image
and employee morale.6-7
The following sections detail further the legal implications of the Smoke-Free
Ontario Act, health implications of tobacco use, trends in smoking, and costs of
tobacco use to the employer.
12 Project Health – Tobacco-Free Living: What Works at Work!
7 Reasons Employers Should Promote Tobacco-Free Living1,8
1. Improved employee health – employees who don’t smoke take fewer sick
days, go on disability less often, and are less likely to retire early because of
poor health
2. Increased productivity – employees may take fewer unscheduled
smoking breaks which could impact productivity
3. Reduced costs – if employees who smoke are helped to quit, the
workplace will reduce potential loss of skills, knowledge, and corporate
memory due to premature death and early retirement; the Conference Board
of Canada has estimated it costs workplaces an additional $3, 396 per year
per smoking employee due to increased absenteeism, reduced productivity,
increased insurance costs, and additional facilities costs (maintenance and
clean up costs associated with littering of and damage caused by discarded
cigarettes)
4. Enhanced job satisfaction – most people who smoke want to quit; a study
from Health Canada’s Tobacco Demand Reduction Strategy shows many
smokers would welcome smoking cessation programs offered by their
employers; the majority of smokers and non-smokers prefer to work in a
smoke-free environment; employees have been shown to be more
productive, have an increased morale, and an increased sense of loyalty in
smoke-free environments
5. Effective setting – workplaces are ideal settings in which to address
tobacco use because many people spend a large proportion of their time at
work; workplaces are convenient locations for people to access information
and support; workplaces can provide the supportive social environment
necessary for quitting smoking; smokers can get support from colleagues
and others who promote health in the workplace; smoke-free workplaces
encourage those who smoke to cut down or quit, and help those who are
already tobacco-free to stay that way
6. Better corporate image – workplaces that are committed to the health of
their employees portray a positive image and are respected within the
workplace and broader community; a better corporate image may help to
attract and retain talented workers
7. Complying with legislation – the Smoke-Free Ontario Act came into
effect on May 31, 2006, making all enclosed public places and enclosed
workplaces 100 per cent smoke-free to protect employers and employees
from exposure to SHS; by providing a smoke-free environment, employers
protect themselves from liability related to the exposure of employees to an
identified workplace hazard
13 Project Health – Tobacco-Free Living: What Works at Work!
The Smoke-Free Ontario Act
Workplaces have a legal responsibility to comply with the Smoke-Free Ontario
Act (SFOA), a provincial strategy to protect non-smokers from exposure to
second-hand smoke, help smokers quit, and to encourage young people to
never start. Enacted on May 31, 2006, the Smoke-Free Ontario Act bans
smoking in all enclosed public places and workplaces at all times, even when
people are not working.
The Smoke-Free Ontario Act defines an
enclosed workplace as the inside of a building,
structure, or vehicle that is covered by a roof
An enclosed workplace is a place where
employees work or go regularly as part of their
work, whether or not they are acting in the
course of their employment at the time.
Washrooms, lobbies, and parking garages are all
part of an enclosed workplace, therefore
smoking is not permitted in any of these
locations. An employer who provides an outdoor shelter for smoking must
ensure it consists of no more than two walls and a roof.
Employer Responsibilities
Ensure employees are aware of the SFOA and where smoking is
prohibited
Post “No Smoking” signs at entrances/exits, in washrooms, lobbies, and
other appropriate locations
Ensure there are no ashtrays or any object that could serve as one within
enclosed workplaces
Ensure that no one smokes in the workplace
Ensure that anyone not complying with the act, does not remain in the
workplace
Employee Rights
An employee cannot be dismissed, threatened to be dismissed,
disciplined, suspended, penalized, intimidated or coerced for obeying
the Act or making a complaint regarding non-compliance with the Act
If an employee experiences any of the above, the employee can direct
complaints to the Ontario Labour Relations Board (www.olrb.gov.on.ca)
14 Project Health – Tobacco-Free Living: What Works at Work!
The Smoke-Free Ontario Act is enforced by Ontario Public Health Units
Public Health Units are authorized by the
Ontario Ministry of Health and Long-Term
Care to investigate complaints and carry out
workplace inspections in order to enforce the
Act. Both employees and employers have a
legal requirement to comply with the
regulations of the Smoke-Free Ontario Act and
could be subject to a fine if convicted of an offence:
Penalties:
Action Fine
Smoke tobacco in an enclosed public place $365
Hold lighted tobacco in an enclosed public place $305
Smoke tobacco in an enclosed workplace $305
Smoke tobacco in a motor vehicle with person under 16 $155
Hold lighted tobacco in a motor vehicle with person
under 16
$155
Hold lighted tobacco in an enclosed workplace $305
Smoke tobacco in a prohibited place or area $305
Hold lighted tobacco in a prohibited place or area $305
Failure of employer to ensure no ashtrays or similar
equipment
$365
Failure of proprietor to give notice that smoking is
prohibited
$365
Failure to post “no smoking” signs when smoking is
prohibited
$240
Source: SFOA, 2006
15 Project Health – Tobacco-Free Living: What Works at Work!
In accordance with the Smoke Free Ontario Act Section 9 (1)(2), the
maximum fine for an individual convicted of smoking tobacco or holding
lighted tobacco in any enclosed public place or enclosed workplace with
no earlier convictions is $1,000 and with one or more previous
convictions for the same offence in the past five years preceding the
current conviction is $5,000.
In accordance with the SFOA Section 9(3)(6), the maximum fine a
corporation can receive for not complying with the SFOA employer
obligations, is $100,000 with no previous convictions and $300,000 with
one or more previous convictions for the same offence in the past five
years preceding the current conviction.
In accordance with SFOA Section 9(4), an individual could receive a
maximum fine of $4,000 and a corporation could receive a maximum fine
of $10,000 if convicted of taking action against an employee because the
employee has acted in accordance with or has sought the enforcement
of the SFOA.
Health Consequences of Tobacco use
Tobacco use is the leading cause of preventable illness and death in Ontario and
across Canada.9 It is estimated that, in Canada, smoking is responsible for 30 per
cent of all cancer deaths and is related to more than 85 per cent of lung cancer
cases.10 Smokers are about 10 to 20 times more likely to develop lung cancer
than non-smokers, and the longer one smokes and the more cigarettes smoked
each day, the greater the risk.10 Smokers are two to four times more at risk of
developing coronary heart disease and stroke than are non-smokers,11 and
cigarette smoking has been identified as the principal underlying cause in 80-90
per cent of chronic obstructive pulmonary disease (COPD) cases.12 Risk of illness
and disease is increased further if a smoker is also exposed to radon or other
harmful chemicals, which are present in some workplaces.10 Smoking also has
adverse reproductive and early childhood effects, including risk of infertility,
preterm delivery, stillbirth, low birth weight, and sudden infant death
syndrome.11
16 Project Health – Tobacco-Free Living: What Works at Work!
All Forms of Tobacco Are Harmful
Tobacco is a plant that contains nicotine, which is the major addictive
component in all tobacco products. However, it is not the nicotine that causes
the most harm. Tobacco smoke contains over 4,000 chemicals, of which 60 are
known carcinogens10 and there are more than two dozen carcinogens in
smokeless tobacco products such as chew or snuff.13 It is these harmful
chemicals, not nicotine, that lead to preventable illness and death.14
Researchers know the most about the health effects of cigarette smoking, as it
remains the most common form of tobacco used. However, any form of tobacco
use (smoked, chewed, or inhaled second hand smoke)9 has been shown to
increase the risk of developing cancers of the bladder, kidney, cervix, colon and
rectum, larynx, mouth and throat (pharynx and esophagus), pancreas, stomach,
nasal cavity, liver, myelogenous leukemia, and some types of ovarian tumours.10
It is important for workplaces to be aware of other available tobacco products so
that health promotion programming can be tailored to the needs of all
employees, including those who use alternate forms of tobacco. See the
Tobacco Industry Products factsheet in the Appendix for a brief description of
other tobacco products.
Nicotine has similar addictive characteristics to drugs such as heroin and
cocaine.15 Most tobacco users are aware of the detrimental health effects of
using tobacco, but find it very difficult to quit even though quitting is the single
most effective thing they could do to enhance the quality and length of their
life.15 This shows the highly addictive properties of nicotine, which is one of the
hardest substance use dependencies to break.
Statistics show that most smokers want to quit, however it usually takes more
than one attempt to stay tobacco-free for life. Of smokers and recent quitters in
Canada in 2011, almost half (46 per cent) reported making at least one quit
attempt in the past year, and 30 per cent had made multiple quit attempts.16
Data from the 2010 Canadian Tobacco Use Monitoring Survey shows former
smokers who have tried to quit an average of 3.4 times before succeeding.17 The
average number of quit attempts made by those requiring more than one quit
attempt before success has been reported to be 6.1.17 Each quit attempt
increases the chances of staying quit, therefore smoking relapse should not be
seen as failure but instead viewed as a step along the journey to becoming
tobacco free.1 Encouraging and supporting quit attempts as much as possible is
an important component of addressing tobacco use among employees.
17 Project Health – Tobacco-Free Living: What Works at Work!
Not Only Tobacco Users Are At Risk
Tobacco smoke not only harms users, but also
those who breathe in the toxic second-hand
smoke. Second-hand smoke is the side-stream
smoke from a lit tobacco product as well as the
smoke exhaled by a person who is smoking.
Second-hand smoke contains the same harmful
chemicals as first-hand smoke (the smoke that is
inhaled) and has been classified as a Group A
human carcinogen by the U.S. Environmental
Protection Agency.18 Each year, exposure to
second-hand smoke while at work, home or
elsewhere causes the death of about 1,000 non-
smoking Canadians.19 Second-hand smoke is also
an irritant, causing congestion, coughing, and irritation to the skin, eyes, nose
and throat, and can worsen allergies or breathing problems like asthma in both
people who smoke as well as those who do not.19 In Waterloo Region in 2009-
2010, 15.5 per cent of non-smoking individuals 12 years of age and older
reported being regularly exposed to second-hand smoke.20
While much has been done to reduce tobacco use and exposure to tobacco
smoke in Ontario, more work is still needed. In Ontario, workers continue to be
exposed to second-hand smoke in enclosed as well as non-enclosed workplaces,
despite implementation of the Smoke-Free Ontario Act (SFOA) in 2006, which
requires all enclosed workplaces in Ontario to be smoke-free. Workplace
exposure, both indoor and outdoor, did not
decrease significantly among Ontario workers
aged 15 years and older between 2005 (31 per
cent of workers reporting exposure) and 2010
(26 per cent of workers reporting exposure).21
In 2011, 14 per cent of Ontario workers were
exposed to second-hand smoke indoors at
work or in a workplace vehicle.22 Ontario
workers in trades, construction, transport,
equipment operations, primary industry,
processing, manufacturing, and utilities
occupations continue to have significantly
higher levels of exposure to second-hand
smoke while working compared to workers in
other occupations.22
18 Project Health – Tobacco-Free Living: What Works at Work!
Tobacco Use Rates
Some occupations and industries display high rates of smoking, much higher
than other occupations and higher than the national and Ontario averages (see
Tables 1, 2, and 3). Workers in these settings are at increased risk of tobacco-
related illness, and their companies are at risk of incurring greater costs
associated with employing tobacco-users. In workplaces where rates of smoking
are lower, addressing employee tobacco use is still cost-effective.
Table 1. Proportion of Current Smokers, Ontario & Canada, 2005 - 2010
Occupation
Proportion of Current Smokers (past 30 days, 15
years +)
Ontario
2005
Ontario
2010
Canada
2005
Canada
2010
Trades, transport and
equipment operators
and related
occupations; primary
industry; processing,
manufacturing and
utilities
32.5% 29.3% 31.5% 28.2%
Sales and service
workers 16.4% 14.4% 21.9% 18.7%
Management;
business, finance and
administration; natural
and applied sciences;
health occupations;
social science,
education,
government service
and religion; art,
culture, recreation and
sport
13.6% 11.8% 15.7% 12.8%
Population average (15
years +) 15.9% 14.0% 18.2% 16.0%
Source: Tobacco Informatics Monitoring System, data from Canadian Tobacco Use
Monitoring Survey, 2005, 2010
19 Project Health – Tobacco-Free Living: What Works at Work!
Table 2. Proportion of Workers
who Smoke by Occupation in
Canada, 2011
Occupation %
Trades, transport, and
equipment operators 28
Processing, manufacturing,
and utilities 24
Management 23
Primary industry 22
Sales and service 20
Business, finance and,
administration 16
Health 12
Natural and applied science
and related occupations 12
Social sciences, education,
government, and religion 9
Art, culture, recreation, and
sport 9
Source: Statistics Canada, CTUMS
2011
Table 3. Prevalence of Smoking
by Industry in Canada, 2011
Industry %
Construction 34
Mining and oil and gas
extraction 29
Transportation and
warehousing 29
Administrative support, waste
management, and remediation
services
27
Accommodation and food
services 27
Wholesale trade 26
Manufacturing 24
Retail trade 23
Real estate and rental leasing 23
Agriculture, forestry, fishing and
hunting 22
Other services (except public
administration) 22
Health care and social
assistance 18
Arts, entertainment, and
recreation 18
Utilities 17
Information and cultural
industries 17
Professional, scientific, and
technical services 16
Public administration 16
Finance and insurance 15
Educational services 10
Source: Statistics Canada, CCHS
2011
20 Project Health – Tobacco-Free Living: What Works at Work!
Waterloo Region
In Waterloo Region in 2010, about one in five adults (19 per cent) over 19 years
of age reported being current smokers, with most smoking daily.23 The rate of
adult smoking in the Region is just above the provincial rate of 16 per cent in
2011.21 The demographic with the highest proportion of smokers in Waterloo
Region is the age group of 50 – 64 years, which makes up a large portion of the
workforce (adults able to work over the age of 15).24
In Waterloo Region (Kitchener Census Metropolitan Area [CMA]), the
unemployment rate in July 2013 was 8.1 per cent,25 just above Ontario’s
unemployment rate of 7.6 per cent in July 2013.26 When looking at the main
industries within Waterloo Region, the manufacturing sector employs 18.4 per
cent of the workforce, followed by the trades sector
at 15.1 per cent.24 The largest proportion of
occupations are in the service sector (22.2 per cent),
and these jobs tend to be characterized by lower
wages, fewer benefits, and more part-time
employment.27 Keeping in mind, the rates of
smoking by occupations and industries presented
previously in Tables 1, 2, and 3, there are many
workplaces in Waterloo Region that likely display
higher rates of tobacco use than the local or
provincial average, and that could greatly benefit
from addressing employee tobacco use. The older
worker population (aged 40 – 80 years) showed the greatest percentage of
growth in the Kitchener CMA between 2001 and 2006 (Table 4),24 indicating the
need to target workplace tobacco-free living interventions towards this age
group.
Table 4. Population Growth by Select Age Groups, 2001 and 2006, Census
Metropolitan Area of Cambridge, Kitchener, and Waterloo
Age Group
Population
2001
Population
2006
Absolute
growth % Growth
0-4 27,960 29,345 1,385 5%
5-19 93,845 96,910 3,065 3%
20-39 133,770 138,180 4,410 3%
40-59 117,580 137,710 20,130 17%
60-79 53,820 60,610 6,790 13%
80+ 11,520 15,350 3,830 33%
Source: Statistics Canada, Census 2001 and 2006
21 Project Health – Tobacco-Free Living: What Works at Work!
Understanding trends in tobacco use among specific groups of people can help
workplaces tailor their tobacco-free living strategies to the make-up of their
workforce. A number of demographic, socio-economic, and related factors are
strongly linked to tobacco use (see Table 5). For instance, there are disparities in
smoking by sex, age, education, and income within Waterloo Region:
1. Smoking is more common among men than women. 22 per cent of
adult men smoke whereas 16 per cent of women smoke.
2. Smoking is most common among adults aged 50 to 64 years
compared to younger adults. While 26 per cent of adults between 50
and 64 years smoke, only 19 per cent of younger adults (19 per cent of
adults 35 – 49 years and 19 per cent of adults 19 – 34 years) report that
they smoke (Table 5).
3. Education and income have a significant impact on smoking. People
with post-secondary education and higher income are much less likely to
smoke (Table 5). This reflects the situation across Canada, where socio-
economic inequalities in smoking, tied to education and income, have
persisted over time.28 Education tends to be lower in occupations that
also experience higher rates of tobacco use.
4. Tobacco use is affected by income. Smoking is far more common
among low earners in Canada than among workers with comparatively
higher earnings. Recent statistics show that Canadians who earn less
than $20,000 are twice as likely to report smoking compared to those
who earn over $80,000 (33 per cent versus 16 per cent, respectively).29
Individuals who work part-time and/or at minimal wage-paying jobs may
be at particular risk of using tobacco products and costing their
workplace as a result – something for employers to keep in mind.
22 Project Health – Tobacco-Free Living: What Works at Work!
Smoking rates also vary across Waterloo Region municipalities and townships,
due to the diverse population mix, living conditions, or other factors that affect
tobacco use such as occupation and income.
Table 5. Proportion of adults aged 18 years and older who were current
smokers* by age group, sex, education and municipality in Waterloo Region,
2009-2010
Factors that affect
tobacco use
current
smokers
(%) Age
19-34 years 19
35-49 years 19
50-64 years 26
Sex
Males 22
Females 16
Education
Less than high school 25E
High school diploma 26
Some post- secondary 19E
Post-secondary degree 15
Factors that affect
tobacco use
current
smokers
(%) Household Income
Less than $40, 000 31
$40, 000 - $69, 000 24
$70, 000 - $99, 999 13E
$100, 000 or more 13E
Don’t know/refused 12E
Municipality (residence)
Cambridge 18
Kitchener 24
Waterloo 12E
Townships 11E
Source: Canadian Community Health Survey, 2009-2010, Statistics Canada,
Share File, Ontario MOHLTC
*Current smokers: currently smokes cigarettes daily or occasionally
E: High sampling variability, estimates must be interpreted with caution
23 Project Health – Tobacco-Free Living: What Works at Work!
Dollars and Cents
It costs employers $3,396 per year more to employ someone who
smokes – Conference Board of Canada (2006)
In 2006, The Conference Board of
Canada (CBC) updated their report to
Health Canada detailing the costs of
employing workers who smoke.
Tobacco use causes poor health, and
poor employee health results in
increased absenteeism, higher health
insurance claims, and a higher number
of workplace injuries.30 A
comprehensive and integrated workplace wellness strategy that includes
support for smoking cessation can help improve worker health and reduce
tobacco-use related costs.30, 31 For a detailed breakdown of estimated costs
associated with smoking, and to estimate the cost at your workplace, refer to
Smoking and the Bottom Line in the Appendix. Statistics Canada provides wage
data by job type, industry, sector, and province, which can be applied to the
absenteeism and lost productivity calculations in the Appendix to obtain a more
accurate cost figure for smokers in a specific category. Smoking occurrence data
such as that provided at the beginning of this section (Tables 1 - 3) can be used
to determine a per-workplace cost by industry or occupation. The CBC
estimated costs associated with employing workers who smoke in their 2006
report, Smoking and the Bottom Line: Updating the Costs of Smoking in the
Workplace. These estimates are provided next. The following section details the
impact of tobacco use on employee absenteeism, employee productivity,
insurance costs, and facilities costs.
Employee Absenteeism
Employees who smoke have been
shown to be absent from work an
additional two days per year
compared to their non-smoking
colleagues.30 The CBC calculated
the average daily per employee
payroll cost of absence from work in
2005 to be $161.44.30 This figure
24 Project Health – Tobacco-Free Living: What Works at Work!
includes average daily wage, taxes, and benefits paid by the employer, including
Canadian Pension Plan, Employment Insurance premiums, and supplementary
health insurance premiums. If this average daily payroll cost is multiplied by the
two additional days of absence estimated for a smoker, the estimated average
annual cost to employ a smoker is $323.30 The actual costs of employing
someone who smokes may be higher or lower than this estimate, which is an
average across industries and occupations.
Employee Productivity
Employee productivity is impacted by
many different factors and can be
measured using a number of different
criteria. One factor used by the CBC for
tobacco use is the amount of time spent
on break during work hours. There are a
number of assumptions within this
premise, but the following arguments have been presented based on employees
who smoke. Note that employees who do not smoke may also engage in
activities that reduce their productive time and may also take unscheduled or
extended breaks for various reasons.
The average Canadian smoker consumes 14 cigarettes per day21 over
approximately 16 hours, assuming no smoking during an average eight hours of
sleep.32 The CBC report assumes most cigarettes are consumed outside of work
time, leaving five cigarettes to be consumed during an 8 hour work day. Of
these, three would likely be consumed during employer-sanctioned breaks,
leaving two additional 15-minute breaks needed to smoke. Additionally, many
workplaces have opted to make their grounds entirely smoke-free: of 129
Canadian organizations surveyed recently, 19 per cent indicated that smoking is
not permitted anywhere on company property.31 A smoke-free grounds policy
would likely require employees to travel a greater distance to smoke, extending
the amount of time needed to consume a cigarette.30 With this assumption, an
employee who smokes now spends an estimated 40 minutes every day
consuming cigarettes outside of sanctioned break time. Using the average daily
per-employee payroll cost mentioned previously and assuming 227 working
days per year (365 days minus 104 for weekends, 10 for holidays, 15 for vacation,
and 9 sick days), the estimated annual cost of lost productivity per smoking
employee is $3,053. 30However, the assumption that time spent smoking a
cigarette is time lost to otherwise productive work may be inaccurate as
employees could discuss matters of business while using tobacco.
25 Project Health – Tobacco-Free Living: What Works at Work!
Insurance Costs
Insurance costs were included in the CBC’s model of costs associated with
employing workers who smoke based on the concept that smokers have greater
health problems and may make more health claims for health benefits which
could increase insurance premiums. It is difficult to identify exactly how much of
an impact smokers have on insurance costs, but the workplace can play an
important role in improving employees’ overall health.30
Smoking Facilities Costs
Since the Smoke-Free Ontario Act was
implemented in 2006, smoking has been
prohibited in enclosed workplaces in Ontario.
Therefore smoking facilities here refers to
items that might be offered for smokers
outdoors, such as ashtrays and designated
smoking areas (DSAs) or ‘smoking shelters.’
(For more information about smoking
shelters, see the Supportive Environment
section.)
The CBC estimates the annual cost of
ashtrays per smoking employee to be $8.50,
with an annual cleaning cost per smoking
employee of $11.34 (for details on how these
cost were estimated please see Smoking and
the Bottom Line in the Appendix), equalling a total annual per smoking
employee facilities cost of $20. This cost provides rationale for instituting a
property-wide smoke-free policy, as no smoking facilities costs would be
incurred (although decreased productivity may result from added distance
smokers must travel to use tobacco, outlined previously). While implementing a
complete smoking ban is an effective approach to promote tobacco-free living
(see the Policy Development section for more information), this may not be a
realistic approach for all workplaces.
26 Project Health – Tobacco-Free Living: What Works at Work!
Summary of Employer Costs Associated with Employees who Smoke
Cost Factor Cost in 2006 (Cdn $)
Increased absenteeism 323
Decreased productivity 3,053
Increased life insurance costs Not available
Smoking facilities costs 20
Workplaces in industries with a high smoking prevalence may have higher costs
associated with employee tobacco use and will have the much to gain from
encouraging and supporting employees to quit. However, all workplaces who
promote tobacco-free living will see benefits such as improved employee
health, greater job satisfaction, and better corporate image. The remainder of
this toolkit provides strategies, tips, tools, and resources to create a
comprehensive workplace wellness program to support tobacco-free living
among employees.
27 Project Health – Tobacco-Free Living: What Works at Work!
References
1 York Region. Good Business... better health. A comprehensive guide for smoke-free workplaces
[Internet]. [place unknown]; date unknown [cited 2013 Jul 10]. Available from: http://www.york.ca/NR/rdonlyres/v4habqqam2oph5zjx7kffjf3cxj6zptdsnswmuydqz3bltijhx2by6jn6hgwf7lertmaezu4yi3qbbsxuvm2ghb4cf/YORK-%23624459-v1-Good_business_better_health_Workplace_guide_1.pdf 2 Patten B, Bovett M. Creating a comprehensive tobacco strategy for your workplace. Ontario
Occupational Health Nurse Association Journal. 2006 winter;5-9 3 Mulligan P. Corporate smoking cessation on Long Island. Health Promotion Practice. 2010;11:182-187.
4 Halpern MT, Taylor H. Employee and employer support for workplace-based smoking cessation: results
from an international survey. Journal of Occupational Health. 2010;52(6):375-382. 5 World Bank. Smoke-free workplaces [Internet]. Washington (DC): World Bank; 2002 [cited 2013 Jun 26].
Available from: https://openknowledge.worldbank.org/handle/10986/9764 6 Fronzi L, Haughey K. Creating a supportive environment: smoke-free policy & cessation support
[PowerPoint slides]. Brant County Health Unit; 2007. 7 Global Smokefree Partnership. Designing a 100% smokefree workplace policy [Internet]. [place
unknown]: Global Smokefree Partnership; date unknown [cited 2013 May 28]. Available from: http://www.globalsmokefreepartnership.org/ficheiro/18.pdf 8 Health Canada. Smoking Cessation in the Workplace: A Guide to Helping Your Employees Quit Smoking
[Internet]. 2008 [cited 2013 Jul 10]. Available from: http://www.hc-sc.gc.ca/hc-ps/pubs/tobac-tabac/cessation-renoncement/index-eng.php#a3.1 9 Cancer Care Ontario. Tobacco: Facts about tobacco [Internet]. [place unknown]: Cancer Care Ontario;
2009 Nov 20 [cited 2013 Jun 17]. Available from: https://www.cancercare.on.ca/pcs/prevention/tobacco/ 10
Canadian Cancer Society. Smoking and tobacco [Internet]. Canadian Cancer Society; 2013 [cited 2013 May 28]. Available from: http://www.cancer.ca/en/prevention-and-screening/live-well/smoking-and-tobacco/?region=on 11
Centers for Disease Control and Prevention. Health effects of cigarette smoking [Internet]. Centers for Disease Control and Prevention; 2012 January 10 [cited 2013 May 28]. Available from: http://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/ 12
Ontario Lung Association. Smoking and tobacco [Internet]. Toronto (ON): Ontario Lung Association; 2011 [cited 2013 Jul 17]. Available from: http://www.on.lung.ca/page.aspx?pid=460 13
Ontario Tobacco Research Unit. Smokeless tobacco and snus: The current evidence for health risks [Internet]. [place unknown]: Ontario Tobacco Research Unit; 2007 [cited 2009 Jan 23]. Available from: http://www.otru.org/pdf/updates/update_june2007.pdf 14
Selby P, Herie M, Dragonetti R, Chapchuk R, Lecce J, Baarker M, fahim M, Parchment S, Sliekers S, Czyzewski K, Timothy V. A comprehensive course on smoking cessation: Essential skills and strategies. [place unknown]: TEACH PROJECT, Centre for Addiction and Mental Health; 2011. 15
Registered Nurses’ Association of Ontario. Integrating smoking cessation into daily nursing practice. Toronto (ON): RNAO; 2007. 16
Reid JL, Hammond D, Burkhalter R, Rynard VL, Ahmed R. Tobacco use in Canada: Patterns and trends, 2013 edition [Internet]. Waterloo (ON): Propel Centre for Population Health Impact, University of Waterloo. 2013 [cited Jul 17]. Available from: http://www.tobaccoreport.ca/2013/TobaccoUseinCanada_2013.pdf 17
Health Canada. Quitting smoking among adults [Internet]. Canadian Tobacco Use Monitoring Survey; 2011 [cited 2013 May 28]. Available from: http://www.hc-sc.gc.ca/hc-ps/tobac-tabac/research-recherche/stat/_ctums-esutc_fs-if/2001-adult-eng.php 18
United States Environmental Protection Agency. Health effects of exposure to secondhand smoke [Internet]. [place unknown]: US EPA; 2011 Nov 30 [cited Jul 10]. Available from: http://www.epa.gov/smokefre/healtheffects.html 19
Canadian Cancer Society. Smoking and cancer [Internet]. Canadian Cancer Society; 2013 [cited 2013 May 28]. Available from: http://www.cancer.ca/en/prevention-and-screening/live-well/smoking-and-tobacco/smoking-and-cancer/?region=on 20
Non smoker second-hand smoke exposure, Waterloo Region and Ontario, 2005, 2007-2008 and 2009-2010 [Internet]. [place unknown]; Canadian Community Health Survey, 2005, 2007-2008, 2009-2010, Statistic Canada, Share File, Ontario MOHLTC; 2012 August 21 [cited 2013 June 27]. Available from: http://chd.region.waterloo.on.ca/en/researchResourcesPublications/quickstats.asp
28 Project Health – Tobacco-Free Living: What Works at Work!
21
Health Canada. Canadian Tobacco Use Monitoring Survey [Internet]. [place unknown]: Health Canada; 2010 [cited 2013 Jul 10]. Available from: http://www.hc-sc.gc.ca/hc-ps/tobac-tabac/research-recherche/stat/index-eng.php 22
Ontario Tobacco Research Unit. Smoke-Free Ontario strategy evaluation report [Internet]. Toronto (ON): Ontario Tobacco Research Unit, Special Report; 2012 Nov [cited 2013 Jul 10]. Available from: http://otru.org/wp-content/uploads/2012/12/OTRU_SER_2012.pdf 23
Smoking Status, Waterloo Region & Ontario, 2005, 2007-2008 & 2009-2010 [Internet]. Canadian Community Health Survey, 2005, 2007-2008, 2009-2010, Statistic Canada, Share File, Ontario MOHLTC; 2012 August 21 [cited 2013 June 27]. Available from: http://chd.region.waterloo.on.ca/en/researchResourcesPublications/quickstats.asp 24
Region of Waterloo Public Health. Profile of workplaces in Waterloo Region. Project Health; 2012 Apr. 25
Statistics Canada. Labour force survey estimate (LFS), by census metropolitan area based on
2006 census boundaries, sex and age group, 3 month moving average, unadjusted for
seasonality. [Internet]. Statistics Canada; 2013 Aug 8 [cited 2013 Aug 27]. Available from:
http://www5.statcan.gc.ca/cansim/pick-choisir?lang=eng&p2=33&id=2820109 26
Statistics Canada. Labour force characteristics, seasonally adjusted, by province (montly).
[Internet]. Statistics Canada; 2013 Aug 9 [cited 2013 Aug 27]. Available from:
http://www.statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/lfss01b-eng.htm 27
Waterloo Region Profile: Statistics, trends & forecasts towards understanding implications for the future. Background document for the 2011 – 2014 strategic planning process.2011 Feb 4 [cited 2013 Jun 24]. Available from: http://www.regionofwaterloo.ca/en/regionalGovernment/resources/waterlooregionprofile.pdf 28
Corsi DJ, Lear SA, Chow CK, Subramanian SV, Boyle MH, Teo KK. Socioeconomic and geographic patterning of smoking behaviour in Canada: A cross-sectional multilevel analysis. Plos ONE. 2013 Feb 28;8(2):1-10. 29
Stonebridge C, Bounajm, F. Smoking cessation and the workplace: Briefing 1 – Profile of tobacco smokers in Canada [Internet]. Ottawa (ON): The Conference Board of Canada; 2013 April [cited 2013 June 7]. Available from: http://www.conferenceboard.ca/e-library/abstract.aspx?did=5422 30
Hallamore, C. Smoking and the Bottom Line: Updating the costs of smoking in the workplace [Internet]. Ottawa (ON): Conference Board of Canada; 2006 [cited 2013 May 28]. Available from: http://www.conferenceboard.ca/e-library/abstract.aspx?did=1754 31
Lamontagne E, Stonebridge C. Smoking cessation and the workplace: Briefing 2 – Smoking cessation programs in Canadian workplaces [Internet]. Ottawa, (ON): The Conference Board of Canada; 2013 June [cited 2013 June 28]. Available from: http://www.conferenceboard.ca/e-library/abstract.aspx?did=5565 32
Hurst M. Who gets any sleep these days? Sleep patterns of Canadians [Internet]. [place unknown]: Statistics Canada; 2008 [cited 2013 Jun 21]. Available from: http://www.statcan.gc.ca/pub/11-008-x/2008001/article/10553-eng.htm
29 Project Health – Tobacco-Free Living: What Works at Work!
GETTING STARTED Planning for Tobacco-Free Living at Work
3.0 G
ettin
g S
tarte
d
30 Project Health – Tobacco-Free Living: What Works at Work!
Creating an Effective Comprehensive Tobacco-Free Living Strategy There is no single correct approach to implementing a comprehensive
tobacco-free living strategy. Each workplace has unique needs when it
comes to helping employees reduce tobacco use. For example, one
workplace may already have a tobacco-free policy and provide benefits
coverage for proven tobacco cessation aids. A workplace like this may
benefit further from implementing a group cessation program in the
workplace, or offering incentives and competitions for reduced tobacco use.
Another workplace may have trouble communicating health promotion
messages and information on smoke-free policies or available supports at
the workplace because employees are spread over a number of worksites or
work various shifts. Regardless of the stage a workplace is at in addressing
tobacco use, health promotion literature suggests that there are eight steps
that help make workplace health promotion strategies successful.1 This
section outlines these steps, which in practice may not always occur in the
order presented.
31 Project Health – Tobacco-Free Living: What Works at Work!
Step 1 – Gain Management and Organizational Commitment In order to create a healthy workplace, it is important that everyone in the
organization is working towards a common goal. The most important part of
any organizational change is management support.2,3,4 See the Supportive
Environments section for more detail regarding management support.
Obtaining senior management
support is essential to obtain
resources such as employee time
and financial support that are
required to initiate and maintain
successful wellness programming.5,6
Additionally, senior managers must
be prepared to see the process
through to the end.3,7 Without this
commitment, the chances of
success are significantly reduced.
Employers may be hesitant to
address tobacco use in the
workplace because they:
do not believe it to be an important health issue,8
do not think it to be their role,9
believe that the time and cost requirements are too high.9
Educating management about the benefits of addressing tobacco use in the
workplace (i.e., for employee health, to reduce organizational costs, and to
increase productivity) is an important step in addressing this health issue.
Further, the majority of smokers and non-smokers prefer smoke-free work
environments,10 and smoke-free workplaces can improve employee morale
and company image.11
All levels of the organization need to be engaged in the wellness approach to
make the strategy a success.12 If some members of the organization are not
supportive of a tobacco-free living strategy, you may need to do some work
to create buy-in.
32 Project Health – Tobacco-Free Living: What Works at Work!
Creating Buy-in
Decision-makers will need to know why a tobacco-free living strategy in the
workplace is important.13 Put together a business case for your organization
and align the business case with current organization priorities, missions and
values.13 Include any relevant information from previous employee interest
surveys that indicate quitting tobacco use to be a health priority for
employees. The Background section of this toolkit provides information to
help create a business case for addressing tobacco use in the workplace.
MOVING FORWARD: The Role of Management in Increasing
Employee Acceptance of Tobacco-free Living in the Workplace
When senior management’s commitment and involvement is visible,
employees are more likely to commit to and participate in creating a healthy
workplace.7,14
Managers play a critical role in organizational change; therefore, the
approach of management representatives is important. An effective
manager is sensitive to employee needs, is trustworthy, walks the talk,
treats others with respect, and communicates well with employees.3,15
It will be important for management representatives to talk to those who are
most resistant to change. Listening to concerns and being compassionate
about others’ feelings, opinions, and fears can help to increase employee
acceptance of change.2,3
Step 2 – Form a Wellness Committee A committee approach is helpful to exchange ideas between employees,
service providers, wellness staff, and management.5 Successful workplace
health initiatives often indicate that program acceptance was achieved using
a committee approach.4,7,14,16,17 Involve all relevant stakeholders (individuals
who have interest or concern in or can be affected by an organization’s
actions), so that committee decisions will consider different perspectives.
A wellness committee is responsible for conducting health needs and
interest assessments, organizing awareness raising and skill building
activities, creating an overall wellness plan and program specific work plans,
assisting with the implementation of strategies, drafting recommendations
for policy development, and evaluating outcomes.
33 Project Health – Tobacco-Free Living: What Works at Work!
Workplaces with a wellness committee or wellness staff have been shown to
have greater insurance coverage for tobacco cessation aids, greater
promotion of cessation in the workplace, and greater enforcement of
smoke-free policies than those without such staff.8
Engaging Employees
There are a number of ways to involve employees in the decision-making
process ranging from consultation to direct involvement in decision-
making.3,15 For example, employees can be consulted about services they
would like through surveys, suggestion boxes, and focus groups.
Employees should have a greater role in the decision-making process if it is
felt that there may be some resistance to the proposed changes.2 Individuals
who are most likely to be resistant should be involved in the process, so that
concerns can be heard and addressed. This also gives employees time to
prepare for the changes.12 Ensure that employee involvement happens early
and often in the process.3,12,18
It is important to outline to employee stakeholders what decisions they will
be able to influence. For example, management may have already made the
decision that there will be changes. In this case, the wellness committee
might be asked to make decisions related to: how the changes are made,
where to start the process, and how long the process should take.
Organizing the Committee
Develop a Terms of Reference for the wellness committee. A Terms of
Reference is a document that defines what the wellness committee is
responsible for and what types of decisions it can make. It should specify the
roles and responsibilities of committee members and outline how decisions
are made. Figure 1 on the next page provides a sample template.
WORKPLACE EXAMPLES: Wellness Committee Terms of Reference
Act Now BC http://www.bcrpa.bc.ca/recreation_parks/documents/ACTIVE_WORKPLACE_web.pdf (page 21)
York Region http://www.york.ca/NR/rdonlyres/jlt37gvt33zifb2hvztjlcmff45ytqqqpo2e2jxn2qcjl66yav4ovkbljjcm342gcmqpgfmqyya5peisd3glud4gcb/WW_Terms_of_Reference.pdf
Peterborough County-City Health Unit
http://www.healthatworkpeterborough.ca/?p=2489
34 Project Health – Tobacco-Free Living: What Works at Work!
Figure 1 - Sample Wellness Committee Terms of Reference
“Committee name”
Terms of Reference
Purpose of the committee
The purpose of the “committee name” is to develop, implement, evaluate and sustain a
comprehensive health promotion strategy in the workplace. The intent is to make healthy
choices the easy choices and ensure that workplace practices are consistent with the healthy
living messages promoted in the workplace. The “committee name” will be responsible for
leading the process to create a comprehensive health promotion strategy in our workplace.
For example, the committee will:
Develop the terms of reference
Complete a workplace tobacco use needs and interest assessment
Set priorities for action
Develop a plan to address identified areas of concern
Carry out the duties outlined in the plan
Manage resources (time, budget)
Evaluate initiatives
Communicate with workplace employees and managers about the committee activities
Membership
The Committee will consist of “number of members” members and will include
representatives from: management, unions/employee associations, employees, health and
safety staff, etc.
Roles and Responsibilities
Chair
The Chair of the “committee name” will be determined by (e.g., rotating through all members,
designated chair each year, etc.). The Chair will be responsible for: calling for agenda items
and drafting the agenda for meetings; ensuring quorum is achieved; and guiding committee
members to work toward a common goal.
Recorder
Decide how the recorder will be chosen (e.g., volunteer at each meeting, rotating recorder,
designated recorder etc.). The recorder will take minutes of each meeting and give to the chair
for distribution within “number of days” days of the meeting.
Members
Members of the “committee name” will:
Attend meetings
Conduct discussions in a professional manner (e.g., constructively dealing with conflict)
Complete tasks as assigned
Decision-making
When making decisions, the “name of committee” will strive for consensus.
If consensus cannot be achieved after a reasonable length of time, decisions will be made by
(e.g., majority vote, designated decision-maker such as a senior manager, etc.).
Meetings
Meetings will be held on the “designated day” of each month or at the call of the Chair. There
will be a minimum of “number of” meetings per year.
A quorum of fifty percent plus one must be met in order to proceed with the meeting.
35 Project Health – Tobacco-Free Living: What Works at Work!
Agenda and Minutes
Have an agenda for each meeting and use a standard format to guide
everyone on what will be accomplished in meetings.
Keep minutes to record committee discussions and post the minutes so that
all employees can see what the committee is discussing and planning. Some
companies have a standard template for all agendas and minutes. Figure 2
provides an example of a minutes template.
Figure 2 – Sample Minutes Template
Name of Committee: ______________________________________
Meeting date _____________________________________________
Participants: _____________________________________________
Regrets: _________________________________________________
Chair: _____________________ Recorder: ____________________
Agenda Item Discussion
Points
Decisions Action (who will
complete the action
and when will it occur)
1.0 Welcome and Introductions
2.0 Review and Additions to Agenda
3.0 Review of Minutes of Previous Meeting
4.0 Business Arising from the Minutes
5.0 New Business
Date, time and location of next meeting: _____________________
Company logo or
wellness brand here
36 Project Health – Tobacco-Free Living: What Works at Work!
Step 3A – Assess Needs and Interests Understanding the needs and interests of employees is an essential part of
developing a comprehensive workplace wellness program.
Before proceeding with a tobacco
cessation initiative, conduct a general
health needs and interest assessment to
determine the health priorities of your
employees and managers.4,7 The results
of the health needs and interest
assessment are critical to determine
readiness for change and will guide
decisions in subsequent phases of the
workplace wellness program.
It is possible that your employees have
health concerns that are not related to tobacco use, or that the timing is not
right for a tobacco cessation initiative in your workplace. Sometimes
workplaces are ready to make changes in one area (e.g., healthy eating)
without being equally ready to make changes in other areas.19 If this is the
case, you may want to focus your wellness efforts on other health promotion
areas and revisit tobacco use as a priority later on.
Methods for assessing employee needs and interests include, but are not
limited to: informal discussions, suggestion boxes, focus groups, and
surveys. Examine other sources of information such as; absenteeism,
productivity, disability claims, and benefit costs to identify if tobacco use is
an issue for your workplace.20
HELPFUL TOOLS: Conduct General Health Needs Assessments
For more information about how to conduct a comprehensive general health needs assessment, visit http://www.projecthealth.ca/understanding-workplace-health/needs-assessmentsurvey-tools
37 Project Health – Tobacco-Free Living: What Works at Work!
Needs Assessment Questions for Workplace Tobacco-Free Living
If tobacco use and tobacco cessation is identified as a priority, workplaces
could conduct another needs assessment to gather information to identify
the types of smoking cessation support employees would be interested in.
Information on employee interests can be helpful in planning awareness
raising and skill building activities and may also help to create buy-in for
supportive environment and policy development initiatives. Developing a
wellness plan that is tailored to the needs of workers can be particularly
useful when addressing tobacco use in the workplace.21
The answers your employees will give to the needs assessment depend on
how the questions are asked. For example, employees may indicate that
they would like lunch and learns about quitting smoking because that is the
type of health promotion activity that is most familiar to them. However, if
you were to ask why employees wanted education, you may find that
employees are having difficulty quitting, or have made unsuccessful
attempts in the past. These are issues that require a comprehensive
strategy, rather than a simple education approach.
To avoid frustration, think about how you will use the information before
adding questions to surveys and only ask employees if they want services
that you will be able to provide.
Figure 3 provides an example of an employee needs assessment survey. Use
this as a guide when developing needs assessment questions for your
specific workplace. Please note that this is not an exhaustive list of questions
but a sample to get you started!
38 Project Health – Tobacco-Free Living: What Works at Work!
EMPLOYEE NEEDS ASSESSMENT: SMOKING CESSATION IN THE WORKPLACE
Part A – About You
1. I am □ Male □ Female
2. My age is ___________ years.
3. Which of the following describes you best? (check one only) □ I am a non-smoker. □ I am an ex-smoker. □ I am a smoker who would like to quit. □ I am a smoker who does not want to quit.
Part B – Non-Smoking Policies and Supports in the Workplace
4. Are you aware of the smoking policy in our workplace?
□ Yes □ No 5. Do you know where smoking is permitted in
our workplace? □ Yes □ No 6. Do you know what cessation supports are
available to employees? □ Yes □ No If yes, please list the cessation supports you
are aware of: ___________________________________ If you are a non-smoker, this completes the questionnaire. Thank you. If you are a current smoker please continue to question 7a and if you are an ex-smoker, please go to question 7b. Part C – About Supporting People Who want to Stop Smoking and Who Want to Stay Quit
7 a. For smokers: Would you like to quit smoking?
□ Yes □ No If yes, how soon.__________________
7 b. For ex-smokers: How long ago did you quit? ___________________________ ___
8. How many times in the past year have you quit smoking for at least 24 hours?
□ None □ Once □ More
9. Have you used any cessation supports in your
previous attempts to quit smoking? □ Yes □ No If yes, please describe the types of supports you have used (e.g., self-help materials, group cessation programs, quit-lines, doctor’s advice, individual counselling, use of nicotine gum, patch, lozenge, inhaler, prescription for Zyban™ or Champix™, etc.) ______________________________________ ___________________________________
10. Would you participate in smoking cessation assistance that was offered through our workplace? □ Yes □ No □ Not sure (please explain) __________________________ _______________________________________
11. What types of support and activities would you use to help you stop smoking or to help you stay smoke-free?
(check as many as apply) □ Group program offered on-site □ Group program offered off-site □ Brief, professional advice □ One-on-one counselling □ Quit medications (patch, nicotine gum, etc.) □ Self-help information (brochures, Websites, etc.) □ Telephone quit-line □ Web-based program □ Contests and challenges □ Health fairs □ Lunch and learn sessions □ Peer support □ 100% smoke-free policy in the workplace □ Other (please explain) ___________________ ________________________________________
12. What would stop you from participating in smoking cessation activities offered though our workplace? (For example, cost, time, family members or spouses not being able to participate, etc.) Please explain. _______________________________________ _______________________________________ _______________________________________ ____________________________________
Thank you for taking the time to complete this survey. This information will assist us in planning cessation activities and supports.
39 Project Health – Tobacco-Free Living: What Works at Work!
AVAILABLE TOOLS: Project Health Can Help!
Project Health staff are available to help you build your business case, create buy-in
among staff and decision-makers, participate in events, offer educational
materials, develop wellness plans, and assist in implementing and evaluating
initiatives. Contact us at 519-883-2287, email us at
[email protected] or visit http://www.projecthealth.ca
Applying Employee Feedback
The information gathered from the needs assessments can be used to tailor
programs to the unique characteristics of your workplace. Health Canada
provides the following tips for tailoring cessation programming:21
Workplace Situation Plan Tailored to the Workplace
High proportion of unionized employees
Involve labour representatives from the outset in addressing smoking as a workplace health, safety, environmental issue
Focus awareness activities on the effects of second-hand smoke on health
Involve family members for social support
High percentage of employees are women
Involve family members for social support
Offer weight management activities and programs (healthy eating and physical activity) together with female-only cessation activities
Provide information on the health effects of second-hand smoke
High proportion of smokers are skilled trades people or labourers
Increase emphasis on cessation assistance
Provide nicotine replacement therapy and other cessation medications as part of extended health-care benefits
High percentage of smokers identify addiction as their main reason for smoking
Offer cessation assistance, include coverage of nicotine replacement therapy and other cessation medications in health benefits
Encourage non-smokers to help others quit
Low percentage of smokers identify a desire to quit
Emphasize the personal and family health consequences of continued smoking
Emphasize health, financial, and other benefits of quitting tobacco use
Workers identify stress as their main reason for smoking
Identify causes of stress in the workplace
Work to remove or modify major sources of stress
Offer workplace stress management seminars together with cessation help
Work with managers to provide assistance to workers during the quitting process
Adapted from: Health Canada, 2010
40 Project Health – Tobacco-Free Living: What Works at Work!
The previous chart is not meant to imply that some strategies are less
important for some workplaces, for example providing health benefits or
encouraging non-smokers to help smokers quit are important for all
workplaces. The chart merely highlights areas that may be particularly
important to focus on for a particular workplace demographic and can act as
a starting point when planning tobacco-free living programming.
Are there Barriers to Addressing Tobacco Use During the Workday?
Even when people have the best intentions of quitting or reducing tobacco
use, elements of the work environment can impede success. Identify factors
in your workplace that act as promoters or barriers to tobacco-free living.
For example, smoke-free policies have been shown to help smokers reduce
tobacco use, even outside of work,22-23 and to reduce exposure to second-
hand smoke in the workplace.24 On the barriers side, the presence of visible
smokers at work (even if smoking outside) can make quitting more
difficult.25
Some workplaces display
higher rates of employee
tobacco use and experience
more barriers to
implementing wellness
programming and eliciting
participation from
employees than others. For
example, workplaces where
employees are spread over
different work locations, work various shifts,24 ,26,27 and where temporary,
part-time, or casual employees are present may experience particular
difficulties reaching all workers with wellness programming and sustaining
participation.28-29 In fact, workers have been reported to drop-out of tobacco
cessation programming due to scheduling issues rather than program
dissatisfaction.29 Communicating with and getting workers to engage in
wellness programming can require a creative approach. Offering incentives
or holding competitions may help to overcome these barriers and increase
participation in smoking cessation programming in the workplace.29, 30 ,31
Lack of management and supervisor support has also been identified as a
barrier to tobacco control programming. 9, 32 Employees prefer, and are more
likely to participate in, tobacco control programming offered during work
41 Project Health – Tobacco-Free Living: What Works at Work!
hours.9 Supervisors may be reluctant to allow workers to take time out of
their work day to attend smoking cessation programming because they
believe this to reduce productivity.9,32 Providing supervisors with
information on the costs associated with employee tobacco use and the
financial (and health) benefits of supporting cessation efforts may convince
them of the importance of allowing employees flexibility around attending
programming.
Step 3B – Assemble a Workplace Tobacco Control Sub-committee Once you establish that addressing tobacco use is a priority for your
workplace through your health needs and interest assessment (step 3A), you
may want to consider creating a tobacco sub-committee. This ensures that
your wellness committee has representatives from all perspectives involved
in promoting tobacco-free living in the workplace.
Develop a terms of reference for the sub-committee and follow the same
process for setting meeting agendas and minutes. Refer back to Step 2 for
more information on this process.
Ensure that enough time is allotted for everyone to participate (e.g., four
hours per month to attend meetings and participate in activities).
If a workplace has an Occupational Health Nurse or smoking cessation
counsellor, it is important that they be involved in committee discussions.
Who to involve
Consider involving representatives from:
Management/supervisors
Health and safety committee
members
Wellness committee members
Human resources
Employees
Union and employee
associations
Fitness providers or
consultants
Purchasing department
Fundraising committee
Social committee
Training and development staff
Marketing and
communications staff
Benefits staff
Health champions
Other relevant workplace
stakeholders
42 Project Health – Tobacco-Free Living: What Works at Work!
Tip: QUIT CHAMPIONS
Invite ‘quit champions’ to be a part of your committee. A quit champion is an
employee that has successfully quit smoking and is passionate about
helping others to do the same. This person can communicate information to
co-workers, provide a “lived-experience” perspective, and listen effectively
to seek feedback from their peers.18 Having champions on your committee
will help to create excitement and buy-in among staff about smoking
cessation initiatives.
Step 4 – Develop a Tobacco-Free Living Program Plan The committee responsible for developing the workplace tobacco-free living
strategy should review the information collected from the needs and
interest assessment and prioritize areas to work on and put together a plan.
The more detailed the plan, the greater likelihood of success.
The plan should:
Clarify the goals of the program
Make program recommendations
Identify required resources (i.e., people and financial)
Establish a timeline for implementation
Plans should address, or at least acknowledge, issues related to how
occupational health and safety, voluntary health practices, and
organizational culture influence the priority areas for your strategy.
When prioritizing actions consider:
The ease of implementing solutions, such as “quick wins” that may
motivate and encourage continued progress
The possibility of making a difference, (e.g., existence of effective
solutions), employer readiness to change, likelihood of success, and
other issues related to workplace policies or politics
The costs that will be incurred if no action is taken
The subjective opinions and preferences of workplace stakeholders,
including managers, employees, and their representatives33
Targeting some activities to certain groups of employees or including
family to reinforce healthy behaviours at home as well as at work34
43 Project Health – Tobacco-Free Living: What Works at Work!
Remember to consider the following components when creating your plan.
Goals and
Objectives
By setting goals and objectives you can track the
progress of your strategy to determine if you have been
successful in your efforts. (See tip box after this chart)
Timeline Establish a timeline for each part of the strategy. Ensure
your timeline is realistic and gives a reasonable time for
activities to be completed.13 If you anticipate a great
deal of resistance allow for additional time in order to
proceed slowly with changes.15
Schedule of
Activities
Determine the best time and frequency to offer
activities.34 Activities should be scheduled at times that
are convenient for participants.34 For example, offering
activities before and after work to meet the needs of
shift workers.34 Participation in events may be increased
if employees are able to attend during work time.
Budget Consider the resources that will be needed to complete
the plan such as staff time, and financial resources for
incentives, printed materials, etc. 35
Existing
Organizational
Processes
Ensure that planned initiatives are integrated into the
overall organization’s goals and priorities so that they
are an everyday part of the organization, rather than an
extra responsibility.4,7,12,33
Promotion and
Communication
Create a communication plan to inform employees
about planned activities.15 If your workplace contains
different types of employees (e.g., office workers and
truck drivers), identify the most effective way to
communicate with each group. Using multiple
communication strategies (refer to the Awareness
Raising section for details).
Consider developing a logo or branding for your health
initiatives to make it easily recognizable to employees.
Education Employees require education on the environmental and
social influences of workplace tobacco use. Without
education, employees may feel that their effort to
reduce or quit using tobacco is solely a personal
responsibility and resist changes to the workplace
environment.36,37
44 Project Health – Tobacco-Free Living: What Works at Work!
TIP: Example Goals and Objectives for Reducing Second-hand
Smoke in the Workplace
Goal: To create an environment that reduces employee exposure to second-
hand smoke.
Objectives:
Specific: What do you want to do?
Example: Create a policy that identifies only one designated smoking
area (DSA) on company property, at least 50 feet away from any building
entrance, exit, or window
Measurable: How much and how often will it be done?
Example: The DSA will be the only location on company property where
smoking is permitted at any time
Attainable: How will it be done?
Example: Employees will be able to use the DSA before and after work,
during lunch, and at break times
Realistic: Will employees be able to follow the policy?
Example: Employees will be made aware of the policy and reminded of it
Timely: When will it be done?
Example: The policy will take effect July 1, 2014
Objective Summary:
To create a policy, to come into effect July 1, 2014, that ensures employees
who smoke do so only in the DSA, to reduce employee exposure to second-
hand smoke.
45 Project Health – Tobacco-Free Living: What Works at Work!
Finally, a comprehensive approach to wellness programming includes all four
of the following key health promotion approaches.
Awareness Raising
Awareness raising activities provide information to employees about the
benefits of tobacco-free living. Examples of awareness raising activities
include providing information in pamphlets, company newsletters, articles
on the company intranet, and posted on bulletin boards.
Skill Building
Skill building activities give employees an opportunity to learn skills that will
help them to live tobacco-free. Examples include: education sessions where
employees learn skills such as creating personal goals and action plans,
mapping out methods to handle trigger situations, learning how to manage
withdrawal symptoms, and learning how to properly use nicotine
replacement therapies.
Supportive Environment
A supportive environment means that the workplace contains sustainable,
ongoing activities that make it easier for employees to stay tobacco-free
throughout the workday. This includes providing cessation support such as
on-site programming and extended health benefits coverage for proven
cessation aids as well as reducing barriers in the workplace environment that
make it difficult for employees to participate in cessation programming.
Policy Development
Workplace policies provide clear definitions of expected employee
behaviour and identify the roles and responsibilities of employees and
managers to ensure supports are in place to help individuals make healthy
choices. For example, a workplace may choose to have a policy that specifies
either when or where individuals can smoke on company property.
More information about each of these strategies is presented in the
Strategies section of this toolkit.
Figure 4 – Workplace Tobacco-Free Living Action Program Plan Worksheet
After completing your workplace tobacco-free living needs and interest assessment, reflect on the areas that were
identified and make a plan to address each area.
Highlight three areas where your workplace is doing well with regard to implementing workplace tobacco-free policies and
practices:
1. _________________________________________________________________________________________________
2. _________________________________________________________________________________________________
3. _________________________________________________________________________________________________
List three priority areas where workplace tobacco-free living practices need improvement:
1. _________________________________________________________________________________________________
2. _________________________________________________________________________________________________
3. _________________________________________________________________________________________________
Once your priority areas have been determined, create a plan to improve each area. Start small, even tackling one area
will make a difference. Make sure you include activities from all four comprehensive health promotion areas: awareness
raising, skill building, supportive environments, and policy.
Goal: ________________________________________________________________________________________________
Objective Target Audience
Strategies Evaluation Method
Timeline Person Responsible
Resources Needed Awareness
Raising Skill Building
Supportive Environment
Policy Development
47 Project Health – Tobacco-Free Living: What Works at Work!
Step 5 – Develop the Evaluation Plan Monitoring and evaluating your workplace wellness initiatives is a very
important step in your wellness programming cycle. This information will
help you identify your successes, and enable you to modify your future
wellness strategies.34 Programs and initiatives should be evaluated on the
goals and objectives set during the planning process.34
There are different levels of evaluation and each offers different types of
evaluation information. These include formative, process and outcome
(short-term and long-term) evaluations; each with their own indicators.
Figures 5a and 5b provide examples for each type of indicator.
Consider tracking process indicators as well as short-term outcome
measures that will indicate if your program has been successful.7 Long-term
successes in the promotion of workplace tobacco-free living can be
somewhat challenging to measure as problems related to tobacco use may
take decades to appear.
Figure 5a –Formative and Process Success Indicator Examples
Formative Indicators
(These indicators identify if interventions will meet the needs of employees)
Appeal of incentives – Do employees like the incentives offered? Do the incentives
motivate staff to participate?
Usability of information or interventions – Is the information targeted, relevant and easily
understood by employees?
Process Indicators
(These indicators identify what works and does not work in your workplace)
Ensure that the committee had representation from all stakeholder groups
Determine how the programs and initiatives were implemented (e.g., designated people
were able to carry out their assigned activities)
Track participation rates, uptake of health risk assessments and use of employee
assistance programs (EAP)
Ask employees how satisfied they are with initiatives
Track costs to determine if programs and initiatives were accomplished according to the
budget
48 Project Health – Tobacco-Free Living: What Works at Work!
Figure 5b –Short-Term and Long-Term Outcome Indicator Examples
TIP: Evaluation Example
If the previous policy example were evaluated (exposure to second-hand smoke),
tracking these indicators can help to determine if the goal and objectives were met.
Do employees understand how to use the DSA? Formative
Was policy implemented on the target date? Process
Have managers had to remind employees to follow the policy? Process
Are managers and employees following the policy? Outcome
Are managers and employees reporting less exposure to SHS in the
workplace? Outcome
If the policy is not being followed, what is the reason? Process
How satisfied are employees with the new DSA? Process
Have there been any negative effects on productivity? Outcome
(These example indicators show whether the program met its objectives)
Short-Term Indicators
Group statistics of employee self-reported tobacco use, exposure to second-hand smoke
Intentions of behaviour change and/or personal goal setting among employees
Increased knowledge34
Self-reported behaviour change34
Positive changes in workplace culture34
Positive sustained environmental changes and/or workplace tobacco-free living policy
implementation
Long-term Outcome Indicators 5,34
Absenteeism rates
Presenteeism rates (productivity losses)
Self-reported job satisfaction and employee morale
Employee turnover
Disability claims
WSIB claims
Prescription drug benefits costs
Changes in risk factors (aggregate HRA data such as blood pressure, cholesterol etc.)
49 Project Health – Tobacco-Free Living: What Works at Work!
Step 6 – Check-in with Management Ongoing communication with management is important throughout the
entire process. This step is essential to guarantee support and approval for
funding or human resources. It’s also needed for a commitment to their role
in the communication of the plan, role modelling, and to ensure leadership
presence.
Once the plan has been drafted, organize a final check-in with management
before proceeding. Present the draft wellness and specific program plans to
managers and any organized labour groups for approval. Include goals,
objectives, and planned activities, as well as plans for communication and
evaluation.
Step 7 – Implement the Plan Now that your plan has been approved, it is time to implement your
strategies. Don’t forget to incorporate the evaluation process into each
activity. Here are some other tips to help make your strategy a success!
Considerations
Launch your initiative!
Once your workplace tobacco-free strategy is ready to implement, it is
important that management representatives (e.g., CEO, President, Director,
union leader, etc.) communicate with employees.34
Communication may need to occur several times in order to ensure that
everyone who is affected is informed of when changes will occur and how
changes will affect them. Use internal communication strategies such as
email, posters, pay-stub attachments, internal websites, and word-of-mouth
to spread the word!
50 Project Health – Tobacco-Free Living: What Works at Work!
Launch the event or initiative with activities such as:
Giveaways
Contests and competitions
Free health assessments with personalized feedback
Loyalty cards as an incentive for selecting healthier options
Engage employees through incentives
Incentives can build motivation by offering rewards for healthy behaviours.
Incentives also create interest in participating.4,7 When incentives are
provided, the company sends the message that it is committed to employee
health.34 To successfully use incentives:34
Ask employees what types of rewards motivate them
Make sure every participant who achieves a goal receives some
recognition. Reward reductions in tobacco use, not just quitting –
reduction is an important step towards quitting
Use incentives to promote your worksite wellness program logo or
branding
Avoid the following:
Rewards for biometric changes (i.e., pounds lost)
Offering incentives for the “best” or the “most” which can discourage
participation
Incentives that are not in keeping with health messaging (e.g., gift
certificates for tanning are not consistent with sun safety
recommendations; restaurant gift certificates are not consistent with
healthy eating messages)
51 Project Health – Tobacco-Free Living: What Works at Work!
TAKE ACTION: Ideas for Incentives
Merchandise that promotes your company (e.g., cups, pens, day timers,
etc.)
Gift certificate for nicotine replacement therapy
Apparel, or reusable grocery bags that promote your wellness messaging
or your wellness branding
Pedometers (higher end) for walking or bicycle
Gift cards for local farmers markets, movie tickets, local attractions,
travel, books, malls, music store, movie rentals, downloadable music or
books, drug stores, or hardware stores, etc.
Booklet of passes to recreational facilities (e.g., swim passes, gym
passes, skating, bowling, etc.)
Useful household items such as magazine subscriptions, beach towels,
cooler bags or backpacks, gardening tools, etc.
Eco-friendly items such as solar-powered cell chargers, crank
flashlight/radios, rain barrels, or biodegradable bags
Event tickets for music or sport events
Paid time off (e.g., Friday afternoon)
A draw for one big item (e.g., active gaming console, electronic devices
such as e-readers, MP3 players, mobile devices, cameras, or DVDs with a
physical activity focus, trips and vacations, spa packages)
See the Skill Building section for more suggestions
Step 8 – Evaluate and Update the Strategy Once your program has been implemented, start collecting the data from
your evaluations. Review the information that you collected during the
evaluation and use it to plan next steps. Complete another needs
assessment to determine if needs are met or if new needs have arisen.
Figure 6 provides an example evaluation survey. Use this as a guide when
developing evaluation questions for your specific workplace. Please note
that this is not an exhaustive list of questions but a sample to get you started!
52 Project Health – Tobacco-Free Living: What Works at Work!
Evaluation Tool 1. How did you hear about the program? (Please check all that apply) □ newsletter □ manager □ staff meeting □ email message □ bulletin boards □ word-of-mouth □ occupational health and safety nurse or other health promoter in the workplace □ other (please explain) _______________________________________ _______________________________________ 2. What was your goal when you joined the group? □ stop smoking □ reduce smoking □ other (please explain) _______________________________________ _______________________________________ 3. Did your goal change as you went through the program? (circle one) □ yes □ no 4. Are you smoke-free today? (circle one) □ yes □ no If yes, please skip to question 8; if no, please continue. 5. Why do you think you started smoking again or did not quit? Please explain. _______________________________________ _______________________________________ 6. Are you thinking about quitting smoking again? □ yes □ no Within 1 year □ yes □ no Within 6 months □ yes □ no Within 3 months □ yes □ no 7. Was the program offered at a time and location that were convenient? Please explain. _______________________________________ _______________________________________
8. Which tools, techniques or resources did you find useful? (Please check all that apply) □ group leader □ breathing/relaxation exercises □ positive self-talks □ handouts and self-help material (please specify) _______________________________________ _______________________________________ □ telephone quit line □ group discussions □ contest □ buddy system □ quit medications (please list) □ other (please specify) ______________________________________ ______________________________________ 9. Is there anything you would suggest adding or changing about the program? _______________________________________ _______________________________________ 10. Was there anything else that you found helpful that was not part of the program? _______________________________________ _______________________________________ 11. How many sessions did you attend? ___________session(s) of _________________ 12. What will you remember most about the program? _______________________________________ _______________________________________ 13. Would you recommend the program to other people? (circle one) □ yes □ no 14. Would you be interested in volunteering to help with other cessation activities or workplace wellness initiatives? If yes, on a separate piece of paper please write your name and phone number and give it to your group leader. (circle one) □ yes □ no
Thank you for completing this evaluation form. And congratulations on your decision to become smoke-free! (Source: Adapted from Stop Smoking: A Program for Women.)
53 Project Health – Tobacco-Free Living: What Works at Work!
The workplace tobacco-free living committee should use the evaluation
data to create a report that: identifies whether goals and objectives were
met, provides indicator results, lists implications of results, identifies any
issues that hindered the process, and most importantly, provides
recommendations for program improvements. This will help you decide
what changes or improvements need to be made and will help you
determine what activities should continue and/or expand.
The committee should present the report to management and other key
stakeholders along with suggested recommendations.34 This can help to
gain further commitment from workplace decision-makers.
Celebrate Your Successes!
Don’t forget to celebrate your successes! Even if things didn’t work out as
you expected them to, your wellness committee has gained insight into
what worked and what didn’t which will help you move forward in future
programming! Share your successes with all employees in your workplace to
create energy, enthusiasm and momentum for your strategy.
54 Project Health – Tobacco-Free Living: What Works at Work!
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[place unknown]: The Health Communication Unit; date unknown [cited 2012 Apr 24]. Available from: http://www.thcu.ca/resource_db/pubs/489887946.pdf 2 Kerber K, Buono AF. Rethinking organizational change: Reframing the challenge of change
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Committee of the Project in Evidence-based Primary Prevention. Healthy eating, physical activity and healthy weights guideline for Public Health in Ontario: A quality review of the Project in Evidence-Based Primary Prevention and the Program in Evidence-Based Care. [place unknown]: Cancer Care Ontario; 2010. 8 Hughes M, Yette E, Hannon P, Harris J, Tran N, Reid T. Promoting tobacco cessation via the
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Vales E. Employees CAN make a difference! involving employees in change at Allstate Insurance. Organizational Development Journal. 2007;25:27-31. 19
Weiner BJ, Lewis MA, Linnan LA. Using organization theory to understand the determinants of effective implementation of worksite health promotion programs. Health Education Research. 2009;24:292-305. 20
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Health Canada. Workplace smoking: Trends, issues and strategies [Internet]. [place unknown]; Health Canada; 2010 [cited 2012 Aug 31]. Available from: http://www.hc-sc.gc.ca/hc-ps/pubs/tobac-tabac/1996-work-travail/index-eng.php 22
Ripley-Moffitt C, Viera AJ, Goldstein AO, Steiner JB, Kramer KD. Influence of a tobacco -free hospital campus policy on smoking status of hospital employees. American Journal of Health Promotion. 2010;25(1):25-28. 23
Ontario Tobacco Research Unit. Workplace restrictions on smoking: Are they good for the smoker, too? [Internet]. Ontario: Ontario Tobacco Research Unit; 2004 [cited 2012 Sept 17]. Available from: http://otru.org/wp-content/uploads/2012/06/update_oct2004.pdf 24
Pirrie M, McGrath H, Garcia JM, Lambraki I, Pieters K. Literature review: Workplace tobacco cessation initiatives for young adults. Waterloo, (ON): Propel Centre for Population Health Impact, University of Waterloo; 2012. 25
Rodriguez-Artalejo F, Urdinguio PL, Guallar-Castillon P, Dublang PG, Martinez OS, Azcarate JD, Aleman MF, Banegas JR. One year effectiveness of an individualized smoking cessation intervention at the workplace: a randomized controlled trial. Occupational and Environmental Medicine. 2003;60:358-363. 26
Van Amelsvoort LG, Jansen NW, Kant I. Smoking among shift workers: more than a confounding factor. Chronobiology International. 2006;23:1105-1113. 27
Sorensen G, Quintiliani L, Pereira L, Yang M, Stoddard A. Work experiences and tobacco use: Findings from the gear up for health study. Journal of Occupational and Environmental Medicine / American College of Occupational and Environmental Medicine. 2009;51(1):87-94. 28
Okechukwu CA, Krieger N, Sorensen G, Li Y, Barbeau EM. MassBuilt: effectiveness of an apprenticeship site-based smoking cessation intervention for unionized building trades workers. Cancer Causes Control. 2009;20:887-894. 29
van’t Klooster J. Smoking cessation in the workplace, what works: A literature review [Internet]. Wellington, (NZ): The Quit Group. 2009 [cited 2012 Jul 24]. Available from: http://www.quit.org.nz/file/research/FINAL%20smoking%20cessation%20in%20the%20workplace%20and%20what%20works%2020090529.pdf 30
Cahill K, Perera R. Competitions and incentives for smoking cessation. Cochrane Database of Systematic Reviews. 2011;(4):CD004307. 31
Hennrikus DJ, Jeffery RW, Lando HA, Murray DM, Brelje K, Davidann B, Baxter JS, Thai D, Vessey J, Liu J. The SUCCESS project: The effect of program format and incentives on participation and cessation in worksite smoking cessation programs. American Journal of Public Health. 2002;92(2):274-279. 32
Morris WR, Conrad KM, Marcantonio RJ, Marks BA, Ribisl KM. Do blue-collar workersperceive the worksite health climate differently than white-collar workers? American Journal of Health Promotion. 1999;13:319-324. 33
World Health Organization. Healthy workplaces: A model for action for employers, workers, policy-makers and practitioners [Internet]. Geneva (CH): World Health Organization; 2010 [cited 2013 Jul 15]. Available from: http://apps.who.int/iris/bitstream/10665/44307/1/9789241599313_eng.pdf 34
Utah Department of Health. Building a healthy worksite: A guide to lower health care costs and more productive employees. Utah: Utah Department of Health; 2010 [cited 2013 Jul 15]. Available from: http://utahworksitewellness.org/pdf/Worksite_Toolkit.pdf 35
Blue Cross Blue Shield Minnesota. Determining a budget for creating a culture of health [Internet]. [place unknown]: Blue Cross Blue Shield Minnesota; date unknown [cited 2012 Feb 28]. Available from: http://www.preventionminnesota.com/objects/Resources_for_Employers/HLTHYWKPLC/culture03budget1_23.pdf 36
Barry CL, Brescoll VL, Brownell KD, Schlesinger M. Obesity metaphors: How beliefs about the causes of obesity affect support for public policy. Milbank Quarterly. 2009;87:7-47. 37
Alvaro C, Jackson LA, Kirk S, McHugh TL, Hughes J, Chircop A, Lyons RF. Moving governmental policies beyond a focus on individual lifestyle: Some insights from complexity and critical theories [Internet]. Health Promotion International. 2010 Aug 13 [cited 2013 Jul 15]. Available from: http://heapro.oxfordjournals.org/content/early/2010/08/13/heapro.daq052.full.pdf+html
56 Project Health – Tobacco-Free Living: What Works at Work!
STRATEGIES Components of a Comprehensive Program to Support Tobacco-Free Living at Work
4.0
Stra
teg
ies
57 Project Health – Tobacco-Free Living: What Works at Work!
Tobacco-Free Living Strategies at a Glance
In order to make the greatest impact on the wellness of employees and your
company, consider all four of the health promotion approaches described in this
section.
Definitions of Success
Each section contains “definitions of success” which describe what a successful
strategy would achieve - a gold standard to strive for. The strategies that
workplaces implement will vary from workplace to workplace, but the end result
(“success”) would be the same. Initially, workplaces may develop their own
goals and strive towards achieving the “definitions of success” over a longer
period of time.
Awareness raising
Awareness raising activities provide information to employees about the benefits of
making healthy choices. Awareness raising activities and resources may include:
Self-help resources*
Telephone counseling
Bulletin boards and posters
Displays and health fairs*
Emails, newsletters & other employee communications
Pamphlets and brochures
Events*
Mobile health technology*
Point-of-decision information
*These activities may be considered skill building if a hands-on learning
component is added (e.g., goal setting, self-monitoring, etc.)
58 Project Health – Tobacco-Free Living: What Works at Work!
Skill building
Skill building activities help to educate employees and develop the necessary skills
to support a healthy choice. Skill building activities and resources may include:
Self-help resources
Telephone counseling
Web and computer based programming
Challenges, contests, and incentives
Pledge cards
Health screening and health risk assessments
Self-monitoring tools
Goal-setting and activity plans
Lunch and learns
Health fairs
Supportive Environment
A supportive environment strengthens and enhances employees’ health practices.
These activities make it easier for employees to make healthy choices. A company
can develop a supportive environment by doing the following:
Supply private phone/computer areas for personal employee use to access
telephone and web-based smoking cessation supports
Provide health benefits that cover proven tobacco cessation aids: nicotine
replacement therapy (NRT), smoking cessation medications (bupropion,
varenicline), and cessation counseling
Remove lifetime maximums on smoking cessation health benefits to allow
employees to make as many attempts as needed to quit tobacco use
Ensure proven tobacco cessation treatments are affordable, requiring
minimal or no co-payments
Ensure the Employee Assistance Program (EAP) provides tobacco
cessation support and employees are aware of how to access these
services
59 Project Health – Tobacco-Free Living: What Works at Work!
Provide employees with access to ongoing tobacco cessation counseling
(individual or group based) whether through an on-site program or
through an external service provider
Ensure all employees are informed of and have access to workplace
tobacco cessation supports, regardless of their worksite, work schedule, or
other work conditions that could be barriers
Provide a positive work environment where coworkers and management
support employees who are trying to quit using tobacco
Policy Development
Policies enhance and sustain healthy practices by clarifying roles and expectations
between employers and employees. Workplace Tobacco-Free Living policies can:
Restrict tobacco use within a certain distance of all entrances and exits
Restrict tobacco use to outdoor designated smoking areas on company
property
Restrict tobacco use on all company property
Restrict tobacco use to specified times of the day
Policies can strengthen support for tobacco-free living in other health
promotion areas covered in this toolkit:
Awareness raising
Skill building
Supportive environments
DID YOU KNOW?: Waterloo Region’s Healthy Workplace Awards
The Waterloo Region Healthy Workplace Awards program recognizes and
celebrates workplaces in Waterloo Region who demonstrate a strong
commitment to improved health for their employees. Workplaces that
implement a healthy tobacco-free living strategy that includes all four health
promotion strategies may be eligible for a Waterloo Region Healthy Workplace
Award. For more information on the health workplace awards see:
http://www.projecthealth.ca/awards-program
60 Project Health – Tobacco-Free Living: What Works at Work!
Awareness Raising
Awareness raising activities can serve a variety of purposes including:
Increasing general knowledge about tobacco use
Advertising workplace tobacco-free living programming
Promoting tobacco cessation resources available in the community
Communicating details of health benefits coverage for tobacco cessation
Informing employees of workplace policies such as designated smoking
areas, smoke-free entranceways or smoke-free grounds
Definitions of Success
Tobacco cessation information and/or educational opportunities are
provided to employees on a regular basis
Employees are familiar with what smoking cessation supports are available
to them at the workplace and in the community
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61 Project Health – Tobacco-Free Living: What Works at Work!
Increase General Knowledge Using awareness raising methods to increase employees' general knowledge
about tobacco use is a good first step to support employees in making a
behaviour change. However, communications must be effective to make a
difference! Some employees may already be prepared to make a quit attempt,
while others may not have intentions of changing their tobacco use. Individual
readiness to change smoking behaviour is an important factor to keep in mind
when planning workplace cessation programming. Cessation programming
tends to cater towards smokers who are ready to make a change,1 but research
indicates the importance of providing a variety of programming options to meet
the needs of employees at all different stages of readiness.2-3
The following sections discuss what information should be provided and
promoted to employees, including:
Health information
Workplace tobacco free living programming
Tobacco cessation resources in the community
Telephone quitlines
Details of benefits coverage
This is followed by methods to communicate the information.
Promote Health Information
Workplaces may be able to increase employee
readiness to quit smoking by highlighting
important health information such as the
health effects of smoking and exposure to
second-hand smoke and the benefits of
quitting tobacco use. Smokers who
understand the health effects of tobacco
use and learn about their increased risk of
developing cancer have been reported to
be more likely to quit.2 Research by
VeUcer and Prochaska demonstrated a
health promotion intervention that
incorporated awareness-raising
about cancer risk related to tobacco
use was effective at reducing tobacco use among workers.4 When used as part
of a comprehensive workplace health strategy, awareness raising activities can
62 Project Health – Tobacco-Free Living: What Works at Work!
be used to reach employees who are ready to make a quit attempt as well as
those not yet contemplating making a change.
To increase employees’ general knowledge about the health effects of tobacco
use, benefits of quitting, and to provide information, tools, and helpful
resources for quitting tobacco use, try the following:
Make self-help resources, booklets, or pamphlets available to employees
Incorporate short articles about the health and financial benefits of
quitting tobacco use in a company newsletter or e-blast
Print the handouts provided in the Appendix of this toolkit and post
them on bulletin boards where employees congregate, like a cafeteria or
break room
LINK TOBACCO-FREE MESSAGING WITH OCCUPATIONAL HEALTH
TRAINING
Information on tobacco is rarely a component of occupational health training.5
Consider combining awareness raising messages on the health effects of
tobacco use and exposure to occupational hazards with mandatory
occupational health and safety training. Consider this example:
Second-hand smoke is more toxic when combined with other chemical
pollutants, increasing the risk of illness of workers who are exposed to these
hazards on the job.6,7,8,9,10,11,12,13 Raising employees’ awareness of the health
risks associated with the combined exposure of second-hand smoke and other
chemicals in the workplace may be an important deterrent to smoking.
Workers who are aware of the independent and combined health effects of
exposure to work-related hazards (e.g., asbestos, dust, and chemicals) and
tobacco smoke have been found to be more likely to quit smoking.10, 14,15 ,16 For
example, craftspersons and labourers across 22 workplaces were significantly
more likely to want to quit smoking when they were concerned about exposure
to job hazards. 10 Thus, linking messaging about the effects of tobacco use with
efforts to increase awareness of occupational health can be an important way
to address tobacco use among some workers.17 This education may be
particularly important for younger male smokers, who tend to minimize their
vulnerability to tobacco-related illness. 2,18
If your workplace does not have an on-site healthcare provider like an
Occupational Health and Safety Nurse, contact your EAP provider or local
Public Health Unit for support
LINKING WITH OCCUPATIONAL HEALTH TRAINING
63 Project Health – Tobacco-Free Living: What Works at Work!
Promote Workplace Tobacco-Free Living Programming Awareness raising activities can be used to support a comprehensive workplace
wellness strategy by informing employees of what is available within the
workplace to support them in quitting or reducing tobacco use. In a study of
support for workplace-based smoking cessation, Halpern and Taylor (2010)
found that more employees than employers thought that their workplace did
not offer smoking cessation supports, indicating a possible lack of awareness
among employees of supports available to them. Even if employees are
interested in cessation programming, they will not participate if they do not
know it is offered.
The Conference Board of Canada’s recent report on Smoking Cessation
Programs in Canadian Workplaces states that to ensure smoking cessation
programs are successful, organizations must actively promote programs to
employees.19 In this report, survey results from 129 Canadian organizations
showed the most common method of communication to be through corporate
intranet sites (38 per cent), followed by health and wellness bulletins (36 per
cent), lunch and learn sessions (31 per cent), and pamphlets or bulletins from the
EAP provider (30 per cent). Many employees may not have access to a computer
every day and corporate intranet sites are not always easy to navigate.19
Therefore to ensure messaging is reaching all employees, workplaces should use
multiple communication channels such as staff meetings, posters, e-mail,
payroll messages, newsletters, intranet, and health and wellness committees.19
COMMUNICATE CESSATION PROGRAMMING TO EMPLOYEES
A group of 878 General Electric employees in the U.S, who work in the aviation,
consumer, energy, broadcasting, plastics, rail, and water industry, reported
better program marketing, including more direct notification to employees
from a supervisor, weekly bulletin, or announcements at meetings, would likely
have resulted in increased recruitment and participation in workplace
programming.20
Promote Tobacco Cessation Resources in the Community Awareness raising activities can also advertise resources, programs, and services
that are available in the community. While providing cessation programming in
the workplace is a great way to address employee tobacco use, it is not always
COMMUNICATE PROGRAMMING TO EMPLOYEES
64 Project Health – Tobacco-Free Living: What Works at Work!
practical. Interventions that may be easily implemented at large worksites are
not always feasible for smaller workplaces who may not have the personnel or
financial resources to plan and implement cessation activities, and who may not
have a sufficient number of employees to run group activities or contests.21 For
these workplaces (typically those with fewer than 50 employees), linking
workers who use tobacco with resources in the community can be an effective
source of support. Overall, raising awareness and/or linking employees to
resources in the community is an important component for workplaces that do
not provide in-house programming, as well as for workplaces that do.
Let workers know about and encourage their use of reliable and effective
cessation programs and resources in their community such as:
Smoker’s Helpline – free telephone, online, and text messaging smoking
cessation counseling
Health Care Providers – all tobacco users should be encouraged to speak
with their health care provider about quitting smoking and options
available to them. Also, many Family Health Teams or Community
Health Centres are now offering specialized smoking cessation
programming for their patients
Smoking Treatment for Ontario Patients Study (STOP Study) - a
research project that aims to discover the most effective methods of
delivering free smoking cessation medication and counseling support to
smokers across Ontario. Employees can check the website for any
upcoming workshops: http://www.stopstudy.ca/Default.aspx
Telephone Quitlines
Promoting telephone
quitlines is an important
strategy for all workplaces,
large and small, to address
employee tobacco use.
Telephone quitlines have
been identified as a cost-
effective method of
addressing employee tobacco
use,22 and smokers have been
shown to be more likely to
participate in telephone
counseling compared to individual or group counseling.23-24
65 Project Health – Tobacco-Free Living: What Works at Work!
HELPFUL TOOLS: Smoker’s Helpline Phone Support
Smoker’s Helpline offers free, confidential, one-to-one telephone support to Ontario
residents looking to change their tobacco use. Trained quit specialists at Smoker’s
Helpline can help employees with:
making a quit plan
quitting methods
managing stress
coping with cravings
withdrawal symptoms
finding other services and resources available within their community
Call toll free 1-877-513-5333 or visit www.smokershelpline.ca for more information.
Communicate Details of Benefits Coverage One important area to ensure employee awareness of, is benefits coverage for
tobacco cessation. The first step is to ensure your workplace actually provides
coverage for proven cessation aids. See the Supportive Environment section of
this toolkit for more information on what to include in your health benefits
coverage.
In many cases, even when benefits are provided, employees are not aware of
these services and thus do not make use of them.1 Researchers estimate that
only between 8 per cent to 30 per cent of employees understand their health
benefits.25,26,27 Even worse, employers do not always know what cessation aids
are covered in their workplace health benefits plan and therefore cannot begin
to promote these to employees.
After ensuring your benefits plan covers proven tobacco cessation aids, be sure
to communicate details of this benefits coverage to all employees, including
information on how to access and utilize these supports.
AWARENESS RAISING STARTS AT THE TOP
In a study aimed at identifying effective strategies for promoting smoking
cessation in workplaces employing 10 to 100 employees, qualitative interviews
with 22 employers in the manufacturing, hospitality, and service sectors
revealed that half of employers who offered smoking cessation benefits were
not aware that they offered these.21 The other half were not able to identify
what, if any, medications or nicotine replacement therapy (NRT) were covered,
and could not identify any resources available in the community to aid
employee smoking cessation efforts.
AWARENESS RAISING STARTS AT THE TOP
66 Project Health – Tobacco-Free Living: What Works at Work!
TIP: UTILIZE LABOUR UNIONS
Labour unions have been identified as integral partners in tobacco control
efforts at some workplaces.28,29,30 Unions can offer well-established
communication channels through which employees may be reached which can
help health promotion efforts.13,30 Unions may be especially useful in reaching
workers who are scattered between worksites (e.g., construction and trades
workers), as communications from unions may be more likely to be read by
workers than communications from employers.12 In a study of construction
workers in the US, researchers noted that collaboration with the union was
important for engaging these workers who experienced “restricted access to
traditional worksite health promotion programs.”13 Workers have reported
trusting information provided by unions, and identifying communications from
their union as effective.30
Awareness Raising Methods For any health promotion strategy to be effective, it must be known and
understood by those it intends to reach. Choosing effective communication
strategies is particularly important to ensure that messaging reaches all
employees including those who work away from a central workplace, who work
at irregular times, or who work as temporary or casual employees. To maximize
reach and understanding, use multiple communication strategies. These do not
need to be expensive or time consuming.
Communication strategies for the workplace may include:
Newsletters
Bulletin board postings
Posters
Pay-stub inserts
Email blasts
Advertisements on in-house
video displays
Pop up messages on
company intranet
Table tents on cafeteria
tables
Communication from
occupational health and
safety or wellness staff at
mandatory trainings
Inserts in work
documentation for shift
workers
More details on some of these methods of awareness raising are provided next.
TIP: Utilize Labour Unions
67 Project Health – Tobacco-Free Living: What Works at Work!
Bulletin Boards and Posters31
Bulletin boards and poster displays are
meant to grab attention and provide short,
focused pieces of information.
For a listing of posters available for loan
from Region of Waterloo Public Health, visit:
http://www.projecthealth.ca/resources/posters-resource-centre
TIP: UTILIZE LABOUR UNIONS
Post in areas where staff usually go (e.g., water fountains,
kitchenette/cafeteria, staff rooms, elevators, stairwells, washrooms)
Change items on a regular basis. After 10-20 views, people tend to stop
“seeing” information32
Make sure details are kept up-to-date
Include “take-away” items (e.g., pamphlets, bookmarks, etc.)
Displays
Similar to bulletin boards, displays can create interest about tobacco use
including health effects and information on quitting smoking. Displays that
include an interactive component can be especially good for drawing attention
and engaging employee interest in and readiness to quit smoking.
For a listing of tobacco-free living displays available for loan from Region of
Waterloo Public Health, visit: http://www.projecthealth.ca/resources/displays
WEBSITE RESOURCES:Downloadable Posters
See the Appendix of this toolkit for the following handouts that can be printed
and posted in the workplace: Health Benefits of Quitting Smoking, Dealing with
Nicotine Withdrawal, and Dealing with Tobacco Cravings.
HELPFUL TOOLS: Downloadable Posters
TIPS: Bulletin Boards and Posters
68 Project Health – Tobacco-Free Living: What Works at Work!
Health Fairs
Workplace health fairs are a great way to provide health information from
various private and public organizations in your community. Health fairs that
offer education, information, and pamphlets are considered to be awareness
raising opportunities. However, skill building can also be incorporated into
health fair displays (e.g., creating a quit plan, tracking smoking patterns, etc.).
For more information on planning a health fair visit:
http://www.projecthealth.ca
Emails
Email messages have the potential to
reach large numbers of people and can
provide immediate feedback to
participants. They are suitable for
employees who have easy access to the
internet with their own personal email
address. Email messages can help
improve confidence in overcoming
barriers and increase perceptions related to benefits of program participation.
They may also help increase readiness to make a quit attempt.33
Emails may help increase the effectiveness of other strategies such as lunch and
learn sessions and quit smoking challenges by promoting and advertising these
workplace offerings.34,35,36,37,38,39,40 Be strategic about the number and length of
emails. Evaluate your communication strategy to ensure that employees are
satisfied with the frequency and usefulness of the information.
TIPS: Emails31
Keep an archive of previous email messages so employees can go back to
relevant topics
Consider increasing the frequency and duration of email messages to
intensify impact
Track the number of emails viewed by participants (request “read” receipts)
Keep emails in a “user-friendly” format and accessible to individuals with
limited computer
Identify employees who will not be reached by email messages and explore
other options to reach them
69 Project Health – Tobacco-Free Living: What Works at Work!
Newsletters (print or electronic)
Newsletter articles and inserts can: enhance support among workers for
workplace wellness programming or policies, provide information and
education, promote activities or special events, and help promote a corporate
culture that supports tobacco-free living.
TIPS: Newsletters31
Be clear about the purpose of the article (is it intended to inform, educate, or
promote?)
Use an active headline that grabs the reader
Identify employees who will not be reached by a newsletter and explore
other options to reach them
Include content that addresses the interests and concerns of the employees
Use clear language; avoid using complicated terms
Consider recognizing employees who have made achievements in living
tobacco-free; whether they have been a support person to someone making
a quit attempt, reduced their exposure to second-hand smoke by making
their home and/or car smoke-free, or made a quit attempt and reached a
milestones (such as 1 month, 3 months, or 6 months tobacco free)
Tie content to larger processes or events that are happening in the
workplace. For example, during year-end budget time, focus on promoting
the use of healthy coping mechanisms to manage stress such as engaging in
physical activity and preparing healthy snacks. In the spring, focus on the
importance of friends and family who provide social support to those trying
to quit using tobacco.
70 Project Health – Tobacco-Free Living: What Works at Work!
Pamphlets and Brochures
Make educational materials available to employees in an accessible area. There
are many accessible self help resources on quitting smoking developed by
different organizations. These can be especially helpful for employees who are
not yet ready to quit using tobacco. They help to increase awareness and
understanding of the negative effects of tobacco use, thereby influencing
motivation to quit.41
TIPS: Pamphlets and Brochures
Use commercial literature racks that are available through office and library
supply stores
Make simple pamphlet holders from flower pots, baskets or other household
items
Several tobacco-free living resources are available from the Resource Centre at:
http://webapps.regionofwaterloo.ca/phrcpamphletordering/.
HELPFUL TOOLS: Self Help Resources
Health Canada – On The Road to Quitting http://www.hc-sc.gc.ca/hc-ps/tobac-tabac/quit-cesser/now-maintenant/road-voie/program-eng.php
Canadian Cancer Society – One Step at a Time http://www.cancer.ca/en/prevention-and-screening/live-well/smoking-and-tobacco/?region=on
The Lung Association – Journey 2 Quit http://www.on.lung.ca/journey
71 Project Health – Tobacco-Free Living: What Works at Work!
Events
Hold a workplace challenge or special event to get employees interested and
involved in workplace tobacco-free living programming. Some examples include
‘quit smoking and win’ contests or ‘go smoke-free homes and cars’ challenges.
Try holding activities in conjunction with national, provincial, and community
events such as:
National Non-Smoking Week (third week in January)
Weedless Wednesday (third Wednesday in January)
World No Tobacco Day (May 31)
Canada’s Healthy Workplace Week (last week in October)
National , provincial, or local quit and win contests
Be sure to plan events well in advance. Include posters, handouts, quizzes,
contests or lunch and learns to celebrate your event.
HELPFUL TOOLS: Links to Events
Visit http://www.nnsw.ca/ for more information on National Non-Smoking
Week and http://www.healthyworkplacemonth.ca for information on Healthy
Workplace Month.
Mobile Health Technology
Mobile Health (mHealth) involves the use of mobile phone technology to
promote health, prevent disease, and provide health care. Such technology
includes, but is not limited to, text messaging and Smartphone applications.42
Text Messages
Text messaging is the most widely adopted and least expensive of mHealth
technologies.42 According to the Canadian Wireless Telecommunication
Association, Canadians send 224 million text messages per day.43 However, the
use of text messaging varies by age, culture, and other demographic factors.
The use of text messaging for preventive health behaviour change is
relatively new. There is evidence of the effectiveness of text messaging in
clinical management of existing health conditions; however,
research on its use in healthy individuals is still in early stages. Early
evidence shows that, at least in the short term, text messaging may
have a positive effect on sustaining positive health behaviours.44-45
72 Project Health – Tobacco-Free Living: What Works at Work!
If you decide to incorporate text messaging into workplace wellness
programming, enhance the effectiveness of text messages by tailoring
messages to individuals: 44,45
Include their name or nickname in the message
Incorporate individual goals into messages
Allow participants to write the messages they will receive
Allow participants to specify days and times when they would like to
receive the messages
Base messages on health behaviour change theory (e.g., stages of
behaviour change) that take into the account an individual’s current
stage of readiness for changing tobacco use
HELPFUL TOOLS: Smoker’s Helpline Text Messaging
Smoker’s Helpline offers text message support to Ontario residents looking to
change their tobacco use. Users can receive text messages customized to their
quit date or they can text key words for additional help when needed. Visit
http://www.smokershelpline.ca for more information.
Smartphone Applications (Apps)
There are Smartphone apps available to help individuals change their tobacco
use. As a motivational tool, they can aid self-monitoring, but they do not change
habits on their own.
Apps related to tobacco use include functions such as:
Tracking smoking habits
Providing tips to manage withdrawal
symptoms
Providing support to control cravings in
various situations
Sharing milestone achievement on other
social media platforms
Connecting with a personal quit coach
It is important to note that most Smartphone apps
that address tobacco use are not based on established theories of health
behaviour change and many do not include evidence-based motivational
features (e.g., goal setting and reinforcement).46
73 Project Health – Tobacco-Free Living: What Works at Work!
HELPFUL TOOLS: Smartphone Applications
Break It Off – Smartphone app created by Smoker’s Helpline and the Canadian
Cancer Society. For details, visit: http://www.breakitoff.ca/
Crush the Crave – Smartphone app created by The Propel Centre for Population
Health Impact at the University of Waterloo in partnership with Leave the Pack
Behind at Brock University, with funding from Health Canada and promotional
support provided by the Canadian Cancer Society. For more information, visit:
http://crushthecrave.ca/
Stop Smoking Center – Online program with a mobile app created by Evolution
Health. For more information, visit: http://www.stopsmokingcenter.net/
Point-of-Decision Information
Providing information at the ‘point-of-decision’ can be an effective strategy to
encourage people to change their behaviour and can also act as a reminder to
comply with Smoke Free Ontario Act (SFOA) legislation.
The SFOA stipulates that smoking is prohibited in all enclosed workplaces in
Ontario. An ‘enclosed workplace’ includes inside a building, structure or vehicle
that an employee works in or frequents during the course of their employment
(whether or not they are acting in the course of their employment at the time).
This also includes common areas such as washrooms, lobbies, and parking
garages. Workplaces should post No Smoking signs at all entrances, exits,
washrooms, lobbies, common areas, and other appropriate locations in order to
be clear about where smoking is prohibited. To order No Smoking signs, contact
your local public health unit. For workplaces in Waterloo Region, contact Region
of Waterloo Public Health: http://chd.region.waterloo.on.ca/ or 519-575-4400.
74 Project Health – Tobacco-Free Living: What Works at Work!
Workplaces are encouraged to adopt, reinforce, and enforce policies that
include further smoking restrictions, beyond the SFOA, such as tobacco-free
grounds, designated smoking areas, or smoke-free entranceways. See the
Policy Development section for more information on how to develop and
implement a tobacco-free policy.
Parking Lots and Property Lines
Parking lots and property lines can be locations of point-of-decision
information. Signs can be placed in parking lots to highlight voluntary workplace
policies such as tobacco-free grounds or designated smoking areas.
Entranceways
In Ontario, smoking is prohibited within a nine metre radius of any entrance or
exit of workplaces that fall under: the Public Hospitals Act, the Private Hospitals
Act, the Mental Health Act, the Nursing Homes Act, the Charitable Intuitions
Act, the Homes for the Aged and Rest Homes Act, and the Independent Health
Facilities Act. No Smoking signs must be placed at all entrances and exits of
workplaces that fall under these acts.
Workplaces that do not fall
under these acts can adopt
voluntary policies to restrict
tobacco use at entranceways
and exits. Post signage to
ensure all employees and guests
are aware of tobacco use
restrictions.
75 Project Health – Tobacco-Free Living: What Works at Work!
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Sorensen G, Emmons K, Stoddard AM, Linnan L, Avrunin J. Do social influences contribute to occupational differences in quitting smoking and attitudes toward quitting? American Journal of Health Promotion. 2002;16(3):135-141. 17
Sorensen G. Worksite tobacco control programs: the role of occupational health. Respiratory Physiology. 2001;128:89–102. 18
Osinubi O, Moline J, Rovner E, Sinha S, Perez-Lugo M, Demisse K, Kipen HM. A pilot study of telephone-based smoking cessation intervention in asbestos workers. Journal of Occupational and Environmental Medicine. 2003;45(5):569-574. 19
Lamontagne E, Stonebridge C. Smoking cessation and the workplace: Briefing 2 – Smoking cessation programs in Canadian workplaces [Internet]. Ottawa, (ON): The Conference Board of Canada; 2013 June [cited 2013 June 28]. Available from: http://www.conferenceboard.ca/e-library/abstract.aspx?did=5565 20
Kim A, Towers A, Renaud J, Zhu J, Shea J, Galvin R, Volpp K. Application of the RE-AIM framework to evaluate incentive intervention for smoking cessation. Journal of Occupational and Environmental Medicine. 2012;54(5):610-614. 21
Tiede LP, Hennrikus DJ, Cohen BB, Hilgers DL, Madsen R, Lando HA. Feasibility of promoting smoking cessation in small worksites: An exploratory study. Nicotine & Tobacco Research. 2006;9(Suppl 1):S83-S90.
76 Project Health – Tobacco-Free Living: What Works at Work!
22
Hughes M, Yette E, Hannon P, Harris J, Tran N, Reid T. Promoting tobacco cessation via the workplace: opportunities for improvement. Tobacco Control. 2011;20(4):305-308. 23
McAfee T. Increasing the population impact of quitlines. Paper presented at: North American Quitline Conference; 2002; Phoenix, AZ. 24
McAfee T, Sofian N, Wilson J, Hindmarsh M. The role of tobacco intervention in population-based health care. American Journal of Preventive Medicine. 1998;14:46-52. 25
Bush TM, McAfee T, Deprey M, Mahoney L, Fellows JL, Cushing C. The impact of a free nicotine patch starter kit on quit rates in a state quit line (Free & Clear). Nicotine Tobacco Research. 2008;10;1511-1516. 26
Boyle RG, Solberg LI, Magnan S, Davidson G, Alesci NL. Does insurance coverage for drug therapy affect smoking cessation? Health Affairs (Millwood). 2002;21:162-168. 27
Burns ME, Rosenburg MA, Fiore MC. Use of a new comprehensive insurance benefit for smoking cessation. Prevention of Chronic Disease. 2005;1:A15. 28
Mitchell RJ, Weisman SR, Jones RM, Erickson D. The role of labor organizations in tobacco control: What do unionized workers think? American Journal of Health Promotion. 2009;23(3):182-186. 29
Barbeau EM, Delaurier G, Kelder G, McLellan D, Sorensen G. A decade of work on organized labor and tobacco control: reflections on research and coalition building in the United States. Journal of Public Health Policy. 2007;28:118–135. 30
Barbeau EM, Goldman R, Roelofs C, Gagne J, Harden E, Conlan K, Stoddard A, Sorensen G. A new channel for health promotion: Building trade unions. American Journal of Health Promotion. 2005;19:297-303. 31
Canadian Council for Health and Active Living at Work. Making it work with active living in the workplace [Internet]. date unknown [cited 2011 Dec 13]. Available from: http://www.cchalw-ccsvat.ca/english/info/Making_It_Work_Eng%20_2.pdf 32
Work Well North Carolina. Move More [Internet]. date unknown [cited 2012 Apr 26]. Available from: http://www.eatsmartmovemorenc.com/Worksites/Toolkit/Move%20More/Move%20More%201-17-12.pdf 33
Plotnikoff RC, McCargar LJ, Wilson PM, Loucaides CA. Efficacy of an email intervention for the promotion of physical activity and nutrition behavior in the workplace context. American Journal of Health Promotion. 2005;19(6):422-429. 34
De Cocker KA, Bourdeaudhuij KA, Cardon GM. The effect of a multi-strategy workplace physical activity intervention promoting pedometer use and step count increase. Health Education Research. 2010;25(4):608-619. 35
Dinger MK, Heesch KC, McLary KR. Feasibility of a minimal contact intervention to promote walking among insufficiently active women. American Journal of Health Promotion. 2005;20(1):2-6. 36
Gilson ND, Brown WJ, Faulkner G, McKenna J, Murphy M, Pringle A, Proper K, Puig-Ribera A, Stahi A. The International Universities Walking Project: development of a framework for workplace intervention using the Delphi technique. Journal of Physical Activity and Health. 2009;6(4):520-528. 37
Haines DJ, Davis L, Rancour P, Robinson M, Neel-Wilson T, Wagner S. A pilot intervention to promote walking and wellness and to improve the health of college faculty and staff. Journal of American College Health. 2007;55(4):219-225. 38
Puig-Ribera A, McKenna J, Gilson N, Borwn WJ. Change in work day step counts, wellbeing and job performance in Catalan university employees: a randomized controlled trial. Promotion and Education. 2008;15(4):11-16. 39
Thomas L, Williams M. Promoting physical activity in the workplace using pedometers to increase daily activity levels. Health Promotion Journal of Australia. 2006;17(2):97-102. 40
Warren BS, Maley M, Sugarwala LJ, Wells MT, Devine CM. Small steps are easier together: a goal-based ecological intervention to increase walking by women in rural worksites. Preventive Medicine. 2010;50:230-234. 41
Registered Nurses’ Association of Ontario. Integrating smoking cessation into daily nursing practice. Nursing best practice guideline: Shaping the future of nursing. Toronto (ON): RNAO; 2007. 42
Cole-Lewis H, Kershaw T. Text messaging as a tool for behavior change in disease prevention and management. Epidemiology Review. 2010;32(1):56-69. 43
Canadian Wireless Telecommunications Association. Facts & figures 2011 [Internet]. 2011 [cited 2012 Feb 14]. Available from: http://cwta.ca/facts-figures/ 44
Fjeldsoe BS, Marshall AL, Miller YD. Behavior change interventions delivered by mobile telephone short-message service. American Journal of Preventive Medicine. 2009;36(2):165-173.
77 Project Health – Tobacco-Free Living: What Works at Work!
45
Gerber Bs, Stolley MR, Thompson AL, Sharp LK, Fitzgibbon ML. Mobile phone test messaging to promote healthy behaviours and weight loss maintenance: a feasibility study. Health Informatics Journal. 2009;15(1):17-25. 46
Rabin C, Bock B. Desired features of smartphone applications promoting physical activity. Telemedicine and e-Health. 2011;17(10):1-3.
78 Project Health – Tobacco-Free Living: What Works at Work!
Skill Building
Knowing that quitting tobacco use or limiting exposure to second-hand smoke
is good for you is one thing. Finding the motivation to act on that knowledge
and make a behaviour change can be something very different. Researchers
have reported tobacco users to be among the most difficult sub-populations to
reach with health promotion programming. Because of this, it is important to
use multiple strategies to address employee tobacco use and efforts should be
made to sustain program participation.1 Skill building activities in the workplace
can help employees increase motivation, confidence, and competence to
initiate a quit attempt and maintain tobacco-free status.
Skill building refers to activities that include a hands-on component such as
workplace challenges, goal setting, or learning skills to cope with cravings.
Some skill building activities can by provided by the workplace, however it may
at times be easier to invite an outside agency to deliver skill building education
for employees. This may be a local community organization, private company or
an Employee Assistance Program (EAP) provider.
Definitions of Success
Skill building opportunities are provided to employees on a regular basis.
4.2 S
kill B
uild
ing
79 Project Health – Tobacco-Free Living: What Works at Work!
Skill Building The following interventions can be used as skill building activities and will be described in this section:
Self help resources
Telephone counselling
Web and computer-based programming
Contests, challenges, and incentives
Pledge cards
Health screening and health risk assessments
Self-monitoring tools
Lunch and learns
Health fairs
Goal-setting and activity plans
Self Help Resources
Self-help interventions aim to provide some of the benefits of intensive
behavioural interventions without the need to attend treatment sessions and
with the ability to be distributed on a much wider scale.2 Workplaces can order
a variety of smoking cessation self-help resources – most free of charge – to
have available to all employees. In order to promote skill building, self-help
resources should be available in combination with other programming that
teaches skills that can be used alongside these resources. Without instructional
programming, self-help resources act only as awareness raising.
A survey of Canadian organizations conducted by the Conference Board of
Canada in January 2013 found that the majority of organizations direct their
employees to self-help resources provided by an external EAP provider (90 per
cent), followed by resources from the Canadian Cancer Society (34 per cent), the
Heart and Stroke Foundation (27 per cent), Health Canada (21 per cent), the
Lung Association (21 per cent), and Smoker’s Helpline (21 per cent).3
HELPFUL TOOLS: Self Help Resources
Health Canada – On The Road to Quitting
http://www.hc-sc.gc.ca/hc-ps/tobac-tabac/quit-cesser/now-maintenant/road-voie/program-eng.php
Canadian Cancer Society – One Step at a Time http://www.cancer.ca/en/prevention-and-screening/live-well/smoking-and-tobacco/?region=on
The Lung Association – Journey 2 Quit http://www.on.lung.ca/journey
80 Project Health – Tobacco-Free Living: What Works at Work!
Telephone Counseling
Research has demonstrated the effectiveness of telephone-based counseling for
smoking cessation across a range of populations both when used on its own4-5
and when combined with nicotine replacement therapy (NRT).6 Telephone
counseling is reported to have the greatest effect on quitting when done in a
proactive manner.7 Even one counseling call is better than none,7 and several
counseling calls can lead to higher initial and longer-term quit rates.8
Telephone counseling may be
particularly effective among workers
who have limited access to workplace-
based health promotion programs as
telephone counseling allows more
flexibility.9 Individuals trying to quit
smoking are more likely to participate
in telephone counseling compared to
individual or group counseling.10,11
Raising awareness about available
telephone counseling services can be
combined with a skill building
component such as learning to track tobacco use patterns or learning to create a
quit plan during a workplace display, information session, or lunch and learn.
Other examples of combining skill building with awareness raising activities
include:
Invite the workplace EAP provider to deliver a lunch and learn
presentation highlighting counseling services they provide (which may
include telephone counseling) and identifying how employees can access
these services. The EAP provider can provide tips on tracking smoking
behaviours and creating a quit plan at the same time.
Invite a representative from Smoker’s Helpline to staff a display in the
workplace to provide employees with information on how to utilize the
telephone, online, and text message support services for cessation. The
representative can provide brief smoking cessation counseling and
initiate the fax referral program to have Smoker’s Helpline proactively
call the employee to initiate telephone counseling.
81 Project Health – Tobacco-Free Living: What Works at Work!
WORKPLACE EXAMPLE
In a smoking cessation program conducted with construction workers,
participants received four to six telephone calls based on motivational
interviewing. These calls included information on health and quitting smoking
that was tailored to an initial survey the individual had completed. At six-
months follow-up, 19 per cent of participants in the experimental group had quit
compared to only 8 per cent of participants in a control group. Tailored
telephone counseling can be an effective tool to reduce tobacco use among
workers.12
The utility of telephone counseling among manual workers was shown by other
researchers in a smoking cessation intervention directed towards members of a
carpenters union.4 In this study, participants received either one or five
telephone calls from a counselor. Participants could call the service as often as
they wanted and were encouraged to use NRT, which was subsidized by a
carpenter trust. At 12 months after the intervention, 22 per cent had quit.
Participants who opted to receive five phone calls were found to be significantly
more likely to quit (28 per cent) compared to those who received only one (19
per cent). Also, use of NRT increased quit rates from 20 per cent to 31 per cent.
Web- and Computer-Based Programming
Web- and computer-based smoking cessation programs have been shown to
improve quit rates compared to generic booklet or email interventions13 or no
intervention at all.14 Computer-based smoking cessation programs have also
produced higher quit rates among groups of workers when combined with other
cessation aids such as use of telephone quitlines or competitions.15
An advantage of web- and computer-based
approaches is that workers with access to a
computer and internet can choose when and
from where to access them. This can impact
work hours less than in-person
programming, and can therefore be more
appealing to some employers.15 Web-based
cessation interventions can reduce tobacco
use, be more effective than self-help books,
be more effective if they provide tailored
messages, and have the ability to enhance
quit rates when combined with other
82 Project Health – Tobacco-Free Living: What Works at Work!
programming, particularly NRT.16 However, employers must consider that not
all workers will have access to a computer.
Some benefits providers or EAP providers now include web-based wellness
programs as part of their services. Workplaces can inquire with their providers
about whether this service is offered and may consider having an information
session where a representative teaches employees how to utilize these services
to support a behaviour change related to tobacco use. There are also free
national web-based programs that employers can advertise to employees to
support behaviour change. While merely advertising these programs falls under
awareness raising, the programs themselves have the capacity to teach
employees various skills to utilize during a quit attempt.
HELPFUL TOOLS: Web-Based Programming
Smoker’s Helpline - www.smokershelpline.ca
Alberta Quits - www.albertaquits.ca/
Nicotine Anonymous - www.nicotine-anonymous.org
Quitnet - www.quitnet.com
Pregnets - http://www.pregnets.org/
Stop Smoking Centre - http://www.stopsmokingcentre.net/
The American Lung Association - http://www.ffsonline.org/
Contests, Challenges, and Incentives
Contests, challenges, and incentives may all be useful strategies when combined with other supports to promote tobacco-free living. While there is a lack of clear and consistent evidence that incentives or competitions increase rates of either short- or long-term cessation,17 a systematic review found that incentives do help to increase participation in smoking cessation programs.18 However, higher enrollment and participation in cessation programming does not necessarily result in higher quit rates than non-incentive programs; quit rates may depend more on participants’ readiness to quit.19
Researchers believe incentives and competitions may:20,21
(1) increase or improve motivation to quit;
(2) increase or improve action to quit; and
(3) increase or improve maintenance of an effort to quit.
83 Project Health – Tobacco-Free Living: What Works at Work!
SUCCESSFUL USE OF INCENTIVES
In a Cochran Collaboration systematic review of the use of incentives to
promote quitting smoking in workplaces, the largest study reviewed (which
included 878 smokers) showed significantly higher quit rates for the incentives
group compared to the control group after six months.22 This program referred
participants to local smoking cessation services in the community rather than
offering their own in-house programming, and offered cash payments of up to
$750 for prolonged (12-month) abstinence.
The Centre for Disease Control and Prevention’s Community Preventive
Services Task Force (CPSTF) recommends the use of incentives and
competitions when combined with additional interventions to reduce tobacco
use among workers.21 These additional interventions may include smoking
cessation groups, self-help materials, telephone support, workplace smoke-free
policies, social support networks, or others. 20Incentives and competitions may
be particularly useful to encourage smokers who have a lower motivation to
quit, who have more difficulty quitting, and who are of lower socio-economic
status, to enroll in workplace cessation programming.19 However, incentives
and competitions are generally well-received by all employees.23-24
Types of Rewards or Incentives
Rewards may be provided for: participation, successful behaviour change, or
both.21 Incentives can be monetary or non-monetary, such as cash paid to
participants, lotteries, gift cards, social recognition, free food, free
pharmacological treatments, paid time off work to attend a cessation program,
a Smartphone to access free smoking cessation apps, a fitness centre
membership, or small gifts such as t-shirts.19
When determining what incentives to use, it is important to conduct a needs
assessment with employees to determine
what types of incentives and strategies
they would prefer.19 Incentives should be
chosen based on available budget and the
strategy chosen to deliver incentives
should be based on the desired behaviour
change.19 See the accompanying box,
“Choosing the Right Rewards,” for
details. If rewards are used to entice
workers to quit, they may be needed over a long period of time as gains in
cessation efforts tend to diminish when rewards of any form are removed.18
84 Project Health – Tobacco-Free Living: What Works at Work!
CHOOSING THE RIGHT REWARDS19
When trying to elicit behavior change, rewards need to match the complexity
of the behavior. Simple behaviours, such as doing something once (like
bringing lunch from home one day or going to the gym one time) generally
only require small, but guaranteed, rewards for people to do them, such as
receiving a small gift certificate or gym towel. For more complex behaviours
like long-term smoking cessation, more complex rewards, increasing incentive
values, and contingency-based approaches tend to be more useful. For
example, providing an initial reward for participating in a smoking cessation
program and then further rewards of increasing value for each month of
abstinence, may produce greater results than only providing an initial reward
for participation.
The Conference Board of Canada found that only 17 per cent of organizations
who provided smoking cessation programs offered incentives to employees for
participation.3 Examples of incentives used by these organizations included:
cash incentives awarded to employees who quit smoking for at least one year;
extra sum of money transferred into a wellness account; points toward
corporate rewards program that can be used to buy items; contests to win prizes
(e.g. iPod, iPad); small gift cards for completing custom in house workplace
program; cash incentives for completing a HRA and one coaching session; and
sessions offered during paid work time.
Involve Family Members and Non-Smoking Coworkers
The social environment can play a significant role in tobacco use, either as a
barrier to, or support for, quitting. Including non-smoking coworkers and family
members (whether they smoke or not) in competitions and challenges can help
promote an environment that is supportive of quitting and can encourage more
smokers to participate in cessation programming.25 Successful incentive
programs involve all individuals in the workplace and reward both tobacco users
and non-users for cessation.18 See the Organizational Change section for more
information on creating a workplace culture that supports quitting.
Coworkers can be incorporated into challenges and competitions as ‘quit
buddies’ and members of support groups. Friendly contests or challenges may
be implemented between different worksites or departments to create a team
atmosphere which can provide important social support to employees
attempting a behavior change.
85 Project Health – Tobacco-Free Living: What Works at Work!
Overall, incentives and competitions are a worthwhile strategy for increasing
participation rates in cessation programming. Increased participation may have
the beneficial result of increased rates of cessation; however incentives might
be needed over a long period of time for sustained cessation. Including all
employees, both smokers and non-smokers, in incentive programs and
competitions and inviting family
members to participate as well may
provide added support for cessation
efforts and will help to create a social
environment supportive of quitting.
Workplace challenges and contests
show management support for
employees efforts to quit tobacco
use, which in itself can promote
cessation among employees.
Try This!
Consider the following before
implementing a quit smoking challenge.
Hold contests and challenges for at least two months to encourage
employees to form new habits26
It can be helpful to link challenges or contests with certain national dates,
such as National Non-Smoking Week or World No Tobacco Day, but don’t
limit programming to these times
Instead of focusing on reducing tobacco use for a short period of time, such
as a week or month, promote sustained behaviour changes, such as creating
a plan to quit tobacco use long-term
Educate employees about healthy living overall, such as physical activity and
healthy eating, which can support tobacco-use behaviour change. Offer skill
building sessions on these wellness topics as part of a challenge or contest
Give healthy living incentives (e.g., stress balls, hand puzzles, reusable water
bottles, etc.) either as one grand prize or in increments (e.g., passport
system that includes attending education sessions and participating in
challenges). An incremental award system may help to motivate people to
participate for the duration of the challenge
Launch the challenge with an activity or event
Divide participants into teams to encourage social support
Have FUN!
86 Project Health – Tobacco-Free Living: What Works at Work!
Pledge Cards
Research shows that people who publicly commit to a behaviour change are
more likely to follow through on the behaviour.27 Pledge cards can be a way to
help employees commit to making a quit attempt and help them to choose a
specific date. Consider having employees sign a pledge to post at their
workspace to continually remind them of the opportunity, their reasons for
quitting, and the benefits of being smoke-free.28 Pledges can also be posted in a
public area in the workplace so that coworkers are aware of employees making
a behaviour change, which not only holds the employee accountable for their
decision but also informs others so they can provide support.28
There are a number of pledge examples online, or you can create your own.
Remember a pledge does not just apply to employees who use tobacco – all
employees can get involved.
Some examples of a pledge include:
Non-tobacco-using employee pledging to support a coworker who is
making a quit attempt by vowing to spend break time together
Making a commitment to reduce overall tobacco use during the work
day
Promising to reduce second-hand smoke by refraining from using
tobacco in the home and/or car
Pledging to quit tobacco use completely by a specified date.
EXAMPLE: Pledge Form
Because I value my health, I pledge to quit using tobacco on
___________________________________________________
Signature ________________________ Date ________________________
87 Project Health – Tobacco-Free Living: What Works at Work!
Health Screening and Health Risk Assessments
Health Risk Assessments (HRAs) are a great way to establish employee’s health
needs and identify problems to address.29 By workplaces identifying the health
risk factors of its employee population (e.g., poor dietary habits, physical
inactivity, smoking), an organization can assess whether a smoking cessation
program should be implemented to reduce smoking rates which could
consequently decrease health benefits costs to the organization.29 The
Conference Board of Canada’s survey of Canadian organizations found that 49
per cent of workplaces offered HRAs to all or some of their employees.29 A large
majority (91 per cent) of these assessments examined smoking habits and
risks.29
Many employees appreciate the opportunity to be screened for health
conditions while at work. This can be especially important for populations that
do not have regular contact with a physician. HRAs are a recommended strategy
for workplaces when they include a health education component.30
When HRAs provide information only, they are considered to be awareness
raising activities, however, skill building can also be incorporated into HRAs, on
topics such as setting goals and creating action plans. Assessment of health
risks with feedback can be effective at motivating behaviour change when
combined with health education programs, with or without additional
interventions. Consider having an occupational health nurse, nurse practitioner,
or physician offer Health Risk Assessments at the workplace. If you do not have
a healthcare professional on staff, check with your EAP provider to see whether
they provide this service.
Health Risk Assessments may include measures such as:
Fagerstrom Test for nicotine dependence
The Why Test for type of nicotine addiction
Carbon monoxide testing
Blood pressure, heart rate, body
composition, etc.
Assessment of dietary habits, compared
against Canada’s Food Guide
Overall levels of physical activity and
sedentary behaviours, compared against
Canadian Physical Activity Guideline
recommendations31
88 Project Health – Tobacco-Free Living: What Works at Work!
Unassisted quit attempts are successful only 3-5 per cent of the time compared
with up to 20 per cent success for those receiving cessation counseling and
medications.32 During HRAs, health care professionals can provide brief
counseling for smoking cessation which can not only increase the number of
people who make a quit attempt, but can also improve the methods and
strategies tobacco users use to quit, resulting in better overall success rates.32
The longer the conversation between the health care professional and the
employee, the more likely the employee is to make a quit attempt. However,
even a minimal (less than 3 minutes) intervention is effective.32 During this brief
counseling, health care providers can
teach employees basic skills such as
how to track smoking patterns and
prepare strategies to deal with triggers.
Health care providers can link
employees to resources in the
community to support quit attempts
and may even set up telephone
counseling by filling out and sending in the Smoker’s Helpline fax referral.
Osinubi et al. reported that proactive telephone counseling was effective in
reaching workers in manual occupations in a study where smokers were
recruited during work-related health screening and divided into two groups, one
that received physician-only advice and one that received telephone
counseling.33 Those in the telephone counseling group showed a higher quit rate
(17 per cent versus 7 per cent) as well as higher participation rates.
HELPFUL TOOLS: Health Risk Appraisal
You Can Make it Happen
For information and tools to assist health care providers to engage in brief
counseling with employees about tobacco use, please visit
http://youcanmakeithappen.ca/
Wellness Council of America (WELCOA)
“Choosing the Health Risk Assessment That’s Right for You” provides
information on hiring a health screening professional
www.absoluteadvantage.org/uploads/files/Choosing_HRA.pdf
Centre for Disease Control and Prevention
Checklist for planning employee Health Risk Appraisal implementation
www.cdc.gov/nccdphp/dnpao/hwi/downloads/HRA_checklist.pdf
89 Project Health – Tobacco-Free Living: What Works at Work!
Self-Monitoring Tools
Prior to setting a quit date, it is important for employees to understand their
smoking patterns. For most, tobacco use is an automatic behaviour that is
influenced by external factors such as people, places, jobs, life events, and how
individuals react to these.34 Taking the time to keep track of current smoking is
an important step in quitting and the best way to do this is by keeping track in a
diary or log book.34 It can be easy to lose track of how much, where, when, and
why one uses tobacco, but keeping track is important when planning a quit
attempt in order to prepare for triggers and temptations.34
HELPFUL TOOLS: Tobacco Use Log
Refer employees to the self-help resources listed below for information on tracking tobacco use, or refer to the Tobacco Tracking Sheet provided in the Appendix of this toolkit.
Health Canada – On the Road to Quitting http://www.hc-sc.gc.ca/hc-ps/pubs/tobac-tabac/orq-svr/index-eng.php Canadian Cancer Society – One Step at a Time: For smokers who want to Quit http://www.cancer.ca/en/prevention-and-screening/live-well/smoking-and-tobacco/?region=on
Smartphone Applications (Apps)
Smartphone apps can be used to set goals,
monitor progress or act as a coaching tool.
See the Awareness Raising section of this
toolkit for more information about accessing
and using Smartphone apps to address
tobacco-free living.
Lunch and Learns
Lunch breaks can be a convenient time to educate employees about the health
effects of tobacco use and exposure to second-hand smoke, the benefits of
quitting tobacco-use, and teach tips and strategies for how to reduce or quit
using tobacco.
AVAILABLE TOOLS: Tobacco Use Log
90 Project Health – Tobacco-Free Living: What Works at Work!
Lunch and learns can be provided by:
A wellness professional such as an occupational health nurse at the
workplace
A health professional from the community, such as a pharmacist
An individual trained in smoking cessation from an EAP
A Project Health staff member
In addition to raising awareness about the hazards of tobacco use and strategies
to quit, skill building can also be incorporated into lunch and learn sessions by
teaching employees how to:
Track smoking patterns
Make a quit plan
Manage withdrawal symptoms
Deal with cravings
Cope with stress
Use nicotine replacement
therapies
Access resources and support
within the community
MORE INFORMATION
For more information on Project Health Lunch and Learns visit
http://www.projecthealth.ca/menu-services/lunch-and-learn, call 519-883-2287 or
email [email protected]. Be sure to request a skill building
component when booking your lunch and learn and ensure you have a minimum
of 10 employees in attendance.
Health Fairs
To turn health fairs from awareness-raising events into skill-building
opportunities, try the following:
• Have a table or booth where employees can write out a quit plan and
sign and date it
• Have a table or booth where employees can answer trivia questions
and learn about effective coping strategies when quitting tobacco
use
• Invite vendors or Project Health staff who can perform Carbon
Monoxide testing
• Invite vendors who can demonstrate how to effectively use nicotine
replacement therapy (Smoker’s Helpline representative, pharmacist,
Project Health staff).
91 Project Health – Tobacco-Free Living: What Works at Work!
MORE INFORMATION
For more information on planning a health fair visit:
http://www.projecthealth.ca/menu-services/health-fairs , call 519-883-2287 or
email [email protected].
Goal-Setting and Activity Plans
A goal is something to strive for. A goal becomes achievable when an activity
plan is created to accompany it. An activity plan is like a road map and provides
the path towards reaching a goal. Having an action plan can improve chances of
quitting tobacco use and staying tobacco-free. A plan should be written down
because writing it requires the individual to think more carefully about what is
needed to accomplish the goal and how it will be done.35
Goals should be S.M.A.R.T. and should be able to answer five questions:36
S = Specific What do you want to do?
M = Measurable How much and how often?
A = Attainable How will you do it?
R = Realistic Can you do it?
T = Timely When will you do it?
Goal-setting and activity planning can easily be incorporated into Health Risk
Assessments, lunch and learn presentations, challenges and contests, as well as
other strategies. Goal-setting can either be pre-determined (e.g., a workplace
challenge that requires employees to quit by a certain date) or self-selected by
the employee. Whether goals are pre-determined or self-selected, activity plans
should be created by each participant to ensure they are tailored to the
individual and take into account employees’ perceived and actual barriers to
quitting tobacco use.
Workplaces can develop their own activity plan templates for employees to use
or make use of those provided in the self-help resources listed previously or in
the Appendix of this toolkit. Skill building activities on goal-setting and creating
activity plans may include the follow:35,37,38
92 Project Health – Tobacco-Free Living: What Works at Work!
1. Write out Reasons35,37,38
When planning to quit tobacco use, it is important for employees to consider
why they smoke, as well as why they want to quit. For employees who identify
more reasons to quit than to continue using tobacco, they may be ready to
move forward right away with planning a quit attempt. If an employee has
better reasons to smoke than
to quit, they may not be
ready to make a quit attempt
and may need more
awareness raising activities
before being ready to learn
and use skills related to
quitting. These individuals
may find it helpful to speak
with an EAP provider or
review a resource such as For
Smokers Who Don’t Want to Quit in the Canadian Cancer Society’s One Step at a
Time series. For employees who identify equal reasons for smoking and for
quitting, it may be helpful to review self-help resources or use web-based
programs or Smartphone applications to learn more about the health, financial,
and social costs of smoking before writing out a quit plan.
See the Appendix for the following useful handouts: Reasons for Change,
Decisional Balance Sheet, and Readiness Ruler.
2. Look Back, Look Forward35,37,38
Changing tobacco use behaviour is
difficult. Many people will try five to seven
times before they quit smoking for good.37
Keep in mind that many employees have
tried to stop using tobacco in the past. It is
important for employees not to view their
past quit attempts as failures but to
instead learn from what worked and what did not and use this knowledge to
guide their next quit attempt. When looking back at previous attempts,
employees can consider why they initially quit, what was easy and hard about
quitting, why they started smoking again, and what they could do differently
this time. If an employee has not tried to quit in the past, they can think about
another accomplishment or behaviour change they’ve made and what worked
well in that situation to discover skills they could apply to quitting tobacco use.
93 Project Health – Tobacco-Free Living: What Works at Work!
3. Prepare for Withdrawal35,37,38
Everyone’s experience is different, but employees can review and prepare for
how they will manage common withdrawal symptoms. See the Dealing with
Nicotine Withdrawal handout in the Appendix for a list of common withdrawal
symptoms and suggestions for coping. If an employee has quit before, it is
useful to think about the specific withdrawal symptoms they experienced and
write down one or two strategies to manage each symptom. It is also useful for
employees to identify what they are worried about when it comes to quitting
tobacco use. Some common fears include weight gain, managing stress, losing
social break time, or a fear of failure. Employees can work to identify these
concerns ahead of time and write down one or more things they can do to
overcome these fears.
HELPFUL TOOLS: Healthy Eating
When planning to quit tobacco use it can be helpful to plan ahead by preparing
healthy foods prior to the quit date that can be used as snacks when managing
cravings and triggers and to keep them stocked and readily available. For more
information, employees can be directed to Canada’s Food Guide at
www.healthcanada.gc.ca/foodguide. Employers may consider combining
smoking cessation programming with healthy eating workplace programming.
For the Project Health Toolkit on Healthy Eating, refer to
http://www.projecthealth.ca/resources/project-health-toolkits/toolkits-healthy-
eating.
4. Tracking Triggers35,37,38
Keeping track of current smoking is an important step in quitting, as mentioned
in the previous section on Self-Monitoring Tools. This phase of planning may be
combined with a workplace contest that challenges employees to track their
tobacco use for an entire week and should include details such as: when, where,
who they were with, how they were feeling, and how strong their craving was.
The contest could challenge employees to cut down their tobacco use over
seven days while tracking their habit. Every time an employee uses tobacco,
they should be reminded to ask themselves “Do I really need this cigarette? Can
I wait or do something else right now?” This will help build coping strategies to
overcome cravings which can build confidence and encourage employees to
make a quit attempt. See the sample Tobacco Tracking Sheet in the Appendix
which could be used in your workplace programming.
94 Project Health – Tobacco-Free Living: What Works at Work!
5. Coping Strategies35,37,38
After tracking tobacco use, employees should be able to identify a list of
triggers. Once an employee decides to quit using tobacco, these triggers will not
go away so it is important to prepare for how to deal with them. It’s helpful to
list out the situations, people, places, and feelings that make the individual want
to use tobacco and then list coping strategies that can be used to avoid tobacco
in each of these trigger situations. The self-help resources listed previously
provide tips and tools for managing trigger situations and cravings and the
Dealing with Tobacco Cravings handout in the Appendix can be used by
employees to help identify triggers and coping strategies.
HELPFUL TOOLS: Physical Activity
Becoming more physically active can help employees keep body weight under
control (a common complaint of quitting smoking) as well as manage food and
nicotine cravings. Physical activity can be an effective alternative to tobacco use
in trigger situations and may be a replacement for activities that would normally
involve tobacco use.
For more information about physical activity, refer to Canada’s Physical Activity
Guide at www.phac-aspc.gc.ca/hp-ps/hl-mvs/pag-gap/index-eng.php.
Employers may consider combining smoking cessation programming with
physical activity workplace programming. For the Project Health Toolkit on
Physical Activity, refer to http://www.projecthealth.ca/resources/project-health-
toolkits/toolkits-physical-activity.
6. Support Systems35,37,38
Encourage employees to tell others, including their health care provider of their
plans to reduce or quit tobacco so they can gain support and be held
accountable for their decision. EAP providers and Smoker’s Helpline can also
provide social support, and employees can be easily linked to these resources in
the workplace. Additionally, workplaces should ensure all employees are
informed of what smoking cessation medications, nicotine replacement
therapies, and counseling supports are
covered in their group benefits plan. As
mentioned previously, challenges and
contests which involve both non-smoking
and smoking employees can be used to
create buddy systems and provide social
support for tobacco-free living efforts.
95 Project Health – Tobacco-Free Living: What Works at Work!
7. Set a Date35,37,38
Choosing a quit date can be difficult, but tobacco users must realize there will
never be a perfect day. Workplaces can support employees to choose a quit date
by offering a contest or challenge for motivation, using Pledge Cards to help
employees commit, and planning a fun launch event at the workplace.
8. Write a Plan35,37,38
Making a plan for the actual quit date can help individuals solidify their
behaviour change and identify sources of support they may use during this
process. The quit plan can include details such as:
The chosen quit date
Reasons for quitting tobacco use
Quit methods to be used
List of support people
Common triggers and associated coping strategies
Rewards for milestones (e.g. 24 hrs, 1 week, 1 month, etc. tobacco-free)
Workplaces can make their own Quit Plan template or use the example Quit Day
Plan that is provided in the Appendix.
9. Maintenance35,37,38
Workplaces should recognize that the
first four weeks of quitting are often the
toughest due to the physical withdrawal
symptoms many people experience
when tobacco use is ceased. Contests,
challenges, and programs should
recognize this and provide daily support
to employees during this time.
Employees should be encouraged to
recognize their feelings – tobacco has been a big part of their life and it is normal
to miss it.
Workplaces can send encouragement through daily emails or postings that
remind employees of their reasons for quitting and provide continued tips and
strategies for managing triggers and withdrawal symptoms. It can be easy to fall
off track during this time, having a few puffs or even a whole cigarette. This can
lead to regular use of tobacco once again. Employees should be encouraged to
view any slip merely as a setback from which to learn from – n0t a failure.
96 Project Health – Tobacco-Free Living: What Works at Work!
Employees should review the situation, where
they were, what triggered them to use
tobacco, and what they could do differently
when this trigger happens again. Set-backs
and trigger situations are important times for
individuals trying to quit to reach out to their
social support networks, utilize workplace
resources such as EAP services or a telephone
quit-line.
97 Project Health – Tobacco-Free Living: What Works at Work!
References 1 Terry PE, Seaverson E, Staufacker MJ, CHES, Tanaka A. The effectiveness of a telephone -based tobacco
cessation program offered as part of a worksite health promotion program. Population Health Management. 2011;14(3):117-125. 2 Lancaster T, Stead LF. Self-help interventions for smoking cessation. Cochrane Database Syst Rev.
2005;CD001118. 3 Lamontagne E, Stonebridge C. Smoking cessation and the workplace: Briefing 2 – Smoking cessation
programs in Canadian workplaces [Internet]. Ottawa, (ON): Conference Board of Canada; 2013 June [cited 2013 June 28]. Available from: http://www.conferenceboard.ca/e-library/abstract.aspx?did=5565 4 Ringen K, Anderson N, McAfee T, Zbikowski SM, Fales D. Smoking cessation in a blue-collar population:
Results from an evidence-based pilot program. American Journal of Industrial Medicine. 2002;42(5):367-377. 5 Osinubi O, Moline J, Rovner E, Sinha S, Perez-Lugo M, Demisse K, Kipen HM. A pilot study of telephone-
based smoking cessation intervention in asbestos workers. Journal of Occupational and Environmental Medicine. 2003;45(5):569-574. 6 Barbeau EM, Goldman R, Roelofs C, Gagne J, Harden E, Conlan K, Stoddard A, Sorensen G. A new
channel for health promotion: Building trade unions. American Journal of Health Promotion. 2005;19:297-303. 7 Miguez MC, Becona E. Evaluating the effectiveness of a single telephone contact as an adjunct to a self-
help intervention for smoking cessation in a randomized controlled trial. Nicotine and Tobacco Research. 2008;10(1):129-135. 8 Stead LF, Perera R, Lancaster T. Telephone counselling for smoking cessation. Cochrane Database of
Systematic Reviews. 2006;1:CD000146. 9 Sorensen G, Barbeau E M, Staddard AM, Hunt MK, Goldman R, Smith A, Brennan AA, Wallance L. Tools
for health: the efficacy of a tailored intervention targeted for construction labourers. Cancer Causes Control. 2007;18:51-59. 10
McAfee T. Increasing the population impact of quitlines. Paper presented at: North American Quitline Conference; 2002; Phoenix, AZ. 11
McAfee T, Sofian N, Wilson J, Hindmarsh M. The role of tobacco intervention in population-based health care. American Journal of Preventive Medicine. 1998;14:46-52. 12
Sorensen G, Barbeau E M, Staddard AM, Hunt MK, Goldman R, Smith A, Brennan AA, Wallance L. Tools for health: the efficacy of a tailored intervention targeted for construction labourers. Cancer Causes Control. 2007;18:51-59. 13
Shahab L, McEwen A. Online support for smoking cessation: A systematic review of the literature. Addiction. 2009;104:1792–1804. 14
Myung S-K, McDonnell DD, Kazinets G, Seo HG, Moskowitz JM. Effects of Web- and computer-based smoking cessation programs: Meta-analysis of randomized controlled trials. Archives of Internal Medicine. 2009;169:929–937. 15
van’t Klooster, J. Smoking cessation in the workplace, what works: A literature review [Internet]. Wellington, (NZ): The Quit Group. 2009 [cited 2012 Jul 24]. Available from: http://www.quit.org.nz/file/research/FINAL%20smoking%20cessation%20in%20the%20workplace%20and%20what%20works%2020090529.pdf 16
Duffy SA, Ronis DL, Richardson C, Waltje AH, Ewing LA, Noonan D, Hong O, Meeker JD. Protocol of a randomized controlled trial of the Tobacco Tactics website for operating engineers. BMC Public Health. 2012;12:335-345. 17
Kouvonen A, Kivimaki M, Oksanen T, Pentti J, Heponiemi T, Vaananem A, Virtanen M, Vahtera J. Implementation of workplace-based smoking cessation support activities and smoking cessation among employees: The Finnish Public Sector Study. American Journal of Public Health. 2012;102(7):56-62. 18
Cahill K, Perera R. Competitions and incentives for smoking cessation. Cochrane Database of Systematic Reviews. 2011;(4):CD004307. 19
Lambraki I. Using incentives in workplace smoking cessation programs [Webinar]. Program Training and Consultation Centre and Propel Centre for Population Health Impact. 2013. Available from: https://www.ptcc-cfc.on.ca/common/pages/UserFile.aspx?fileId=258352 20
Leeks KD, Hopkins DP, Soler RE, Aten A, Chattopadhyay SK. Worksite-based incentives and competitions to reduce tobacco use: A systematic review. American Journal of Preventive Medicine. 2009;38:S263-S274.
98 Project Health – Tobacco-Free Living: What Works at Work!
21
Community Preventive Services Task Force. Increasing tobacco use cessation: The guide to community preventive services [Internet]. The Community Guide: What works to promote health. USA.gov; 2013 Jun 3 [cited 2013 Mar 5]. Available from: http://www.thecommunityguide.org/tobacco/cessation/index.html 22
Volpp KG, Troxel AB, Pauly MV, Glick HA, Puig A, Asch DA, Galvin R, Zhu J, Wan F, DeGuzman J, Corbett E, Weiner J, Audrain-McGovern J. A randomized, controlled trial of financial incentives for smoking cessation. New England Journal of Medicine. 2009;360(7):699-709. 23
Central East Tobacco Control Area Network. Literature review: Workplace cessation project. Ontario; 2012 Feb 24. 24
Halpern MT, Taylor H. Employee and employer support for workplace-based smoking cessation: results from an international survey. Journal of Occupational Health. 2010;52(6):375-382. 25
Jason LA, Jayaraj S, Blitz CC, Michaels MH, Klett LE.). Incentives and competition in a worksite smoking cessation intervention. American Journal of Public Health, 80(2), 205-206. 26
Lally P, Van Jaarsveld CHM, Potts HWW, Wardle J. How habits are formed: Modelling habit formation in the real world. Eur J Soc Psychol. 2010;40:998-1009. 27
Cotterill S, Richardson L. Can pledging increase civic activity? A literature review on developing community Pledgebanks [Internet]. Communities and Local Government. 2009 [cited 2013 Jul 12]. Available from: http://www.communities.gov.uk/documents/communities/pdf/1328160.pdf 28
Health Canada. On the road to quitting [Internet]. Ottawa (ON): Health Canada; 2012 [cited 2013 Jul 11]. Available from: http://www.hc-sc.gc.ca/hc-ps/pubs/tobac-tabac/orq-svr/index-eng.php 29
Lamontagne E, Stonebridge C. Smoking cessation and the workplace: Briefing 2 – Smoking cessation programs in Canadian workplaces [Internet]. Ottawa, (ON): Conference Board of Canada; 2013 June [cited 2013 June 28]. Available from: http://www.conferenceboard.ca/e-library/abstract.aspx?did=5565 30
Task Force on Preventive Services. The Guide to Community Preventive Services. Assessment of health risk with feedback plus health education with or without other interventions [Internet]. [place unknown]: Task Force on Preventive Services; 2010 [cited 2011 Dec 28]. Available from: http://www.thecommunityguide.org/worksite/ahrf.html 31
Centers for Disease Control and Prevention. Worksite health promotion – Evaluation (physical activity) [Internet]. Atlanta (GA): US Centers for Disease Control and Prevention; 2011 [cited 2011 Dec 28]. Available from: http://www.cdc.gov/workplacehealthpromotion/evaluation/topics/physical-activity.html 32
McLean K, d’Avernas J, Lynch D, Appah F, Steibelt E. Brief counseling for tobacco use cessation: A guide for health professionals. [place unknown]: Program Training and Consultation Centre;2008. 33
Osinubi O, Moline J, Rovner E, Sinha S, Perez-Lugo M, Demisse K, Kipen HM. A pilot study of telephone-based smoking cessation intervention in asbestos workers. Journal of Occupational and Environmental Medicine. 2003;45(5):569-574. 34
Canadian Cancer Society. Second hand smoke is dangerous [Internet]. Canadian Cancer Society; 2013 [cited 2013 June 7]. Available from: http://www.cancer.ca/en/prevention-and-screening/live-well/smoking-and-tobacco/second-hand-smoke-is-dangerous/?region=on 35
Health Canada. On the road to quitting [Internet]. Ottawa (ON): Health Canada; 2012 [cited 2013 Jul 11]. Available from: http://www.hc-sc.gc.ca/hc-ps/pubs/tobac-tabac/orq-svr/index-eng.php 36
Health Canada. Eat well be active educational toolkit [Internet]. Health Canada; 2013 Jun 25 [cited 2013 Jul 12]. Available from: http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/educ-comm/toolkit-trousse/plan-3b-eng.php 37
The Lung Association. Journey 2 quit: A workbook to help you quit smoking. [place unknown]: The Lung Association; date unknown. 38
Canadian Cancer Society. For smokers who want to quit. [place unknown]: Canadian Cancer Society; 2007.
99 Project Health – Tobacco-Free Living: What Works at Work!
Supportive Environment
A supportive environment includes ongoing, sustainable activities that make it
easy for everyone to make healthy choices. In a supportive workplace
environment, employees are not restricted from taking action to improve or
maintain their health. Healthy behaviours are reinforced and sustained through
supportive social networks within a healthy and safe physical environment.
Definitions of Success
Employees work in an environment that encourages and supports
tobacco-free living
Employees feel supported within the workplace to quit or reduce
tobacco use
The workplace is an ideal setting in which to address employee tobacco use.
Workplaces can provide a large number of people access to a supportive social
culture that, when combined with individual supports such as on-site tobacco
cessation programming and access to tobacco cessation medications, can
encourage employees to stop tobacco use and remain tobacco-free over the
long term. Individuals are more likely to achieve success when the overall
workplace environment is supportive of the desired change.1
Environmental factors in the workplace can either support tobacco cessation
success or encouraging continued tobacco use. For example, a workplace that
provides minimal benefits coverage for tobacco cessation medications and no
tobacco cessation supports may discourage quit attempts, while workplaces
that offer comprehensive benefits coverage for tobacco cessation aids and in-
house tobacco cessation supports make quit attempts easier. Changes to the
physical environment often require fewer resources and personnel, and are
more sustainable than approaches that focus exclusively on individual behavior
change.1
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Every workplace is unique, so tailoring
tobacco-free living strategies to address
the specific needs of a workplace will be
more likely to result in success than
adopting a generic approach. For example,
workers in occupations such as
construction, trades, manual labour, and
service jobs tend to display higher rates of
smoking than workers in office jobs1,2,3 and
are more likely to be exposed to pro-
tobacco influences at work, such as peer
smoking and lack of tobacco cessation
programming. Addressing the
environment in these workplaces may be
particularly important. Challenges specific
to certain occupations are identified in the
following sub-sections on Organizational
Culture and Physical Work Environment.
This section on Supportive Environment is divided into four sub-sections, each
focusing on a different aspect of a supportive environment described in the
following paragraphs.
4.3.1 – Organizational Culture
When implementing a tobacco-free living strategy, it is important to consider
the overall organizational culture, how it impacts tobacco-use, and what can be
changed to ensure tobacco-free living is supported within the workplace.
This section provides an overview of organizational culture as well as tips and
tools on the following topics to ensure each is addressed in a way that promotes
tobacco-free living in the workplace:
Management support
Social norms and co-worker support
Job stress and strain
Work schedules
101 Project Health – Tobacco-Free Living: What Works at Work!
4.3.2 – Physical Work Environment
The physical work environment can help or hinder smoking cessation in the
workplace.
This section reviews:
Designated smoking areas / smoking shelters
Hazards in the workplace
Unique challenges for outdoor, transient, transportation, service, and
hospitality workers
4.3.3 – Extended Health Benefits
Providing adequate coverage for proven tobacco cessation aids has been
identified as the “single most cost-effective health insurance benefit for adults
that can be provided to employees.”4,5 ,6
This section provides information on:
Extended health benefits for smoking cessation
Nicotine Replacement Therapy (NRT)
Smoking cessation medications (bupropion, varenicline)
Smoking cessation counseling
4.3.4 – Smoking Cessation Programming
Offering tobacco cessation programs and services at the workplace: sends a
strong message of management commitment and support for employee health
and well-being; can help target hard-to-reach employees; and allows for follow-
up support, which is particularly important for smoking cessation.7 Offering
cessation programming in the workplace in addition to ensuring other
environmental factors support cessation provides the most comprehensive
approach to promote tobacco-free living.
This section covers:
Smoking cessation clinical practice guidelines
Comprehensive workplace smoking cessation programming
Levels of support the workplace can provide
Checklist for assessing smoking cessation programs
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Each of these areas of a supportive environment are important to address, but
you may want to focus on one or two areas first before moving on to others.
Creating small changes can make bigger changes easier as more people become
supportive of them. Definitions of Success for each topic will be provided along
with more in-depth information to help you apply these to your specific
workplace.
References
1 Chin DL, Hong O, Gillen M, Bates MN, Okechukwu CA. Cigarette smoking in building trades workers: The
impact of work environment. American Journal of Industrial Medicine. 2012;55(5):429-439. 2 Cunradi CB, Lipton R, Banerjee A. Occupational correlates of smoking among urban transit operators: a
prospective study. Substance Abuse Treatment, Prevention, and Policy. 2007;2(36). 3 Barbeau EM, Kreiger N, Soobader MJ. Working class matters: Socioeconomic
disadvantage, race/ethnicity, gender, and smoking in NHIS 2000. American Journal of Public Health. 2004;94:269-278. 4 Warner KE. Cost effectiveness of smoking-cessation therapies. Interpretation of the evidence and
implications for coverage. Pharmacoeconomics. 1997;11(6):538–549. 5 Cummings SR, Rubin SM, Oster G. The cost-effectiveness of counseling smokers to quit. Journal of the
American Medical Association. 1989;261(1):75–79. 6 Coffield AB, Maciosek MV, McGinnis JM, Harris JR, Caldwell MB, Teutsch SM, Atkins D, Richland JH,
Haddix A. Priorities among recommended clinical preventive services. American Journal of Preventive Medicine. 2001;21(1):1–9. 7 Canadian Centre for Occupational Health & Safety. Environmental tobacco smoke (ETS): Workplace
policy [Internet]. 2011 [cited 2013 Jan 27]. Available from: www.ccohs.ca
103 Project Health – Tobacco-Free Living: What Works at Work!
4.3.1 Organizational Culture
A supportive organizational culture promotes the physical and mental health
and well-being of employees. This section outlines organizational factors that
can contribute to increased tobacco use in the workplace such as, work
schedules, job stress, and social norms. Strategies to manage these factors are
outlined, including: coworker support, positive management practices, and
rewards and recognition.
Definitions of Success
Coworkers and management support employees trying to quit tobacco
use
Employees who smoke are encouraged in a positive way to stop using
tobacco and to remain tobacco-free for life
Tobacco-free living is considered normal among workers
Employees feel recognized for their efforts and management actively
seeks to reduce job stress and job strain
Work schedules are as consistent as possible
Tobacco-free living programs are accessible to all workers, regardless of
work schedule or shift, and to the extent possible, offered at times and
locations that are convenient and affordable for employees
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Organizational Factors that Affect Tobacco Use
When implementing a tobacco-free living strategy, it is important to consider
how the overall organizational culture impacts tobacco use, and what can be
changed to ensure tobacco free living is supported within the workplace. The
following section identifies and describes workplace factors that affect tobacco
use in the workplace.
Work Schedules
Various types of work schedules can influence employees’ use of tobacco within
the workplace:
Tightly regimented schedules can lead to workers taking routine
‘smoke breaks’ together, which can reinforce smoking. 1,2
Inconsistent work schedules can lead to working more than a regular
full-time (40 hour) work week, and has been associated with greater
likelihood of smoking among both men and women.3,4
Greater total hours worked has been associated with higher smoking
rates and more difficulty quitting.5,6,7,8,9
SHIFT WORK AND TOBACCO USE
Addressing organizational culture is an important component of a tobacco-free
living strategy, particularly for workplaces with shift workers. Shift workers are
more likely to initiate smoking compared to non-shift workers and are
especially difficult to reach with workplace smoking cessation programming.10
For example, one research study found that night shift truck drivers and dock
workers have been found to be less likely to participate in smoking cessation
programming in the workplace compared to workers who work day shifts.11
For more information related to shift work and health effects, visit the
Canadian Centre for Occupational Health and Safety website at:
http://www.ccohs.ca/oshanswers/ergonomics/shiftwrk.html
105 Project Health – Tobacco-Free Living: What Works at Work!
Job Stress
Job stress includes any negative physical or emotional response to conflict
between job demands and the control an employee has in meeting these. Stress
at work is closely related to an increase in employee smoking, heavier smoking,
and decreased quitting.1,12,13,14,15,16,17,18 Various factors impact job stress and can
influence tobacco use among employees:
High job demands combined with low control can lead to continued
tobacco use as a coping mechanism for stress.19
Low rewards on the job, such as lack of adequate recognition for a job
well done and lack of adequate pay relative to job effort has been
associated with continued smoking and greater amount smoked.16
Physically demanding work and working in adverse conditions (e.g.,
bad weather, at a height, being exposed to noise, working in a fast-
paced environment) has also been associated with increased likelihood
of smoking.20 These job demands can negatively affect physical and
mental health, and smoking may be used as a coping mechanism.
Social Norms
The social norms that are part of an organization’s culture have an affect on
individual workers’ behaviour and attitude toward tobacco use and cessation.
Social norms of tobacco use differ depending on the workplace setting and
nature of the work. Smoking is less likely to be perceived as socially acceptable
in office settings, where rates of smoking are typically lower than in manual
occupations such as construction, trades, manufacturing, transportation, and
service and
hospitality.21 Workers
in physically
demanding jobs tend
to work in teams
where peer smoking
has been reported to
be a social activity,22
and may increase the
likelihood of smoking
among these
workers.23
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Smoking can be influenced by and can influence the following social norms
within the workplace:
When smoking is perceived as normal and acceptable in the workplace it
can prolong employee smoking and may even lead new employees to
start smoking.1,23
Workers who experience tobacco use as normal and acceptable in the
workplace feel less pressure from coworkers to quit smoking24
The presence of coworkers who smoke makes quitting even more
difficult.25 In some cases, coworkers actually discourage quitting, which
may result in reduced confidence in ability to quit.4
Being included in a ‘smoking group’ at work can be perceived as
important for social inclusion,26 and this can undermine efforts to quit or
reduce tobacco use.
New employees have even been reported to take up smoking to feel
included in the social group at work.1
Workers who do not smoke may feel left out of social ‘smoke break’
gatherings. 27 This may lead to conflict in the work environment, with
smokers and non-smokers viewing each other negatively.27 This conflict
has been shown to negatively impact the work performance of those
who do not smoke.27
Work Conditions that Contribute to More Smoking, Challenges
Quitting, and Greater Relapse: 5
Involuntary overtime
Inflexible hours
Piece-rate work
Repetitive and monotonous tasks
Work requiring constant attention to the task at hand
Arbitrary supervision
Workplace hazards
Deskilled work
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Strategies to Promote a Positive Organizational Culture
Support from managers and coworkers is essential to foster an organizational
culture that promotes tobacco-free living. When employees feel rewarded for
their work and feel that their schedules allow for participation in health and
wellness activities, they are supported to address personal health behaviours
such as tobacco use.
The following section describes how coworker support, management practices,
and rewards/recognition can promote tobacco-free living within the workplace
and address the factors described previously: work schedules, job stress, and
social norms.
Coworker support
Coworkers can provide positive social pressure at work which seems to be useful
in motivating smokers to quit. For example, in a large study of truck drivers and
dock workers in the US, workers who believed their coworkers viewed their
smoking negatively were more likely to want to quit.11 Furthermore, the
likelihood of smoking has been found to decrease by 34 per cent if a coworker
quits.28 Perceived support from coworkers and supervisors for cessation efforts
is positively associated with quitting.29 Try the following strategies:
Incorporate both smoking and non-smoking coworkers in tobacco-free
living programming to create a positive social environment that fosters
quitting.30
Use buddy systems in tobacco cessation programming with smoking and
non-smoking coworkers. Buddy systems are reported to be an important
determinant of successful quitting.31
Supportive Management Practices
Management support for tobacco-free living has a strong influence on
organizational culture. When employees believe that management is genuinely
concerned about worker well-being, they are more likely to participate in health
promotion programming at the workplace.32 Workers with employers who have
made positive changes to the work environment are more likely to make
individual smoking cessation behavior change.33
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Management support and concern may be demonstrated by:
Showing genuine interest in employee health by assessing employee
needs and interests. Refer to the Getting Started section of this toolkit
for more information.
Supporting the creation and maintenance of a workplace wellness
committee. Workplaces with a wellness committee or wellness
coordinator usually support tobacco-free living more than workplaces
without such positions.14,34
Allowing workers to attend smoking cessation programming during the
work day at flexible times and in convenient locations.24 Employees
prefer, and are more likely to participate in cessation programming that
is offered during work hours.35 Attrition from workplace smoking
cessation programs has been attributed to worker schedules, rather than
participant dissatisfaction with programming.17
Consulting employees about their work, negotiating workload with
employees using two-way communication, and offering constructive
feedback to employees.2,3 When employers allow for more control in the
workplace it is associated with smoking fewer cigarettes, quitting
smoking, and lower relapse rates.5,7,8,9
Keeping demands on employee time and energy reasonable.3,4
Moderate work demands on the job combined with high job resources
(e.g., job control, rewards) was found to increase the likelihood of
successful quitting.5 This is probably because having moderate work
demands provides a distraction from quitting, which can help quit
efforts.
Ensuring that work conditions and job demands do not negatively
influence employees’ personal relationships.3
Role modelling
healthy behaviours
and supporting
tobacco-free living in
the workplace (e.g.,
be physically active
during breaks, follow
smoke-free policies,
etc.).
109 Project Health – Tobacco-Free Living: What Works at Work!
Rewards and Recognition
Continued smoking and greater amount smoked has been associated with low
rewards on the job, such as lack of adequate recognition for a job well done.16
Therefore, it is important to ensure employees feel valued and recognized. Ask
employees what types of rewards motivate them to ensure the rewards are
effective. Here are some ideas for rewarding employees for a job well done:
Give written recognition from supervisor, manager or human resources
(e.g., letter of recognition, hand-written notes, certificates of
achievement, etc.)
Give verbal recognition from supervisor or manager (e.g., positive
feedback, making an announcement in team meetings, etc.)
Ask employees to nominate other co-workers for awards
Give special privileges (e.g., an afternoon off or flexible hours)
Provide a healthy staff lunch or dinner (e.g., chili with a whole wheat bun
and a salad, healthy pizza with salad or fruit dessert) or other perks such
as “Fresh Fruit Fridays”
Provide opportunities to learn new skills (e.g., internal job shadow,
educational activities, or other opportunities for individual growth)
Give gift cards for malls, local stores, entertainment, sporting events, a
spa day, a massage, bookstores, downloadable music, etc.
Have management complete a task for employees, such as cooking a
healthy meal, serving in the cafeteria, car wash etc.
Have an office event during a special holiday or occasion with awards
given out for the best team decoration
Consider when rewards are given
and make sure that there is a fair
and consistent process for
rewarding employees. Give
individual and team rewards when
they are warranted. Also keep in
mind that rewards that are given
often may eventually be expected
by employees, which begins to feel
more like an entitlement not a
reward – in this case be spontaneous and creative in your employee rewards.
110 Project Health – Tobacco-Free Living: What Works at Work!
References
1 Pirrie M, McGrath H, Garcia JM, Lambraki I, Pieters K. Literature review: Workplace tobacco cessation
initiatives for young adults. Waterloo, (ON): Propel Centre for Population Health Impact, University of Waterloo; 2012. 2 Rodriguez D, Romer D, Audrain-McGovern J. Beliefs about the risks of smoking mediate the relationship
between exposure to smoking and smoking. Psychosomatic Medicine. 2007;69:106-113. 3 Artazcoz L, Cortes I, Escriba-Aguir V, Cascant L, Villegas R. Understanding the relationship of long
working hours with health status and health-related behaviours. Journal of Epidemiology and Community Health. 2009;63(7):521-527. 4 Sorensen G, Pechacek T, Pallonen U. Occupational and worksite norms and attitudes about smoking
cessation. American Journal of Public Health. 1986;76:544-549. 5 Albertsen K, Borg V, Oldenburg B. A systematic review of the impact of work environment on smoking
cessation, relapse and amount smoked. Preventative Medicine. 2006;43:291-305. 6 Erikson W. Work factors and smoking cessation in nurses’ aides: a prospective cohort study. BioMed
Central Public Health. 2005;5:142. 7 Sanderson DM, Ekholm O, Hundrup YA, Rasmussen NK. Influence of lifestyle, health, and work
environment on smoking cessation among Danish nurses followed over 6 years. Preventative Medicine. 2005;41:757-760. 8 Janzon E, Engstrom G, Lindstrom M, Berglund G, Hedblad B, Janzon L. Who are the
“quitters?” a cross-sectional study of circumstances associated with women giving up smoking. Scandanavian Journal of Public Health. 2005;33:175-182. 9 Erikson W. Work factors and smoking cessation in nurses’ aides: a prospective cohort study. BioMed
Central Public Health. 2005;5:142. 10
Van Amelsvoort LG, Jansen NW, Kant I. Smoking among shift workers: more than a confounding factor. Chronobiology International. 2006;23:1105-1113. 11
Sorensen G, Quintiliani L, Pereira L, Yang M, Stoddard A. Work experiences and tobacco use: Findings from the gear up for health study. Journal of Occupational and Environmental Medicine / American College of Occupational and Environmental Medicine. 2009;51(1):87-94. 12
Azagba S, Sharaf MF. The association between workplace smoking bans and self-perceived, work-related stress among smoking workers. BMC Public Health. 2012;12(123):1-8. 13
John U, Riedel J, Rumpf HJ, Hapke U, Meyer C. Associations of perceived work strain with nicotine dependence in a community sample. Occup Environ Med. 2006 Mar;63(3):207-211. 14
Sorenson G, Barbeau E, Hunt M, Emmons K. Reducing social disparities in tobacco use: a social contextual model for reducing tobacco among blue-caller workers. American Journal of Public Health. 2004;94:230-239. 15
Kuper H, Marmot M. Job strain, job demands, decision latitude, and risk of coronary heart disease within the Whitehall II study. Journal of Epidemiology and Community Health. 2003;57:147-153. 16
Kouvonen A, Kivimaki M, Virtanen M, Pentti J, Vahtera J. Work stress, smoking status, and smoking intensity: an observational study of 46 190 employees. Journal of Epidemiology & Community Health. 2005;59:63–69. 17
van’t Klooster, J. Smoking cessation in the workplace, what works: A literature review [Internet]. Wellington, (NZ): The Quit Group. 2009 [cited 2012 Jul 24]. Available from: http://www.quit.org.nz/file/research/FINAL%20smoking%20cessation%20in%20the%20workplace%20and%20what%20works%2020090529.pdf 18
Cunradi CB, Lipton R, Banerjee A. Occupational correlates of smoking among urban transit operators: a prospective study. Substance Abuse Treatment, Prevention, and Policy. 2007;2(36). 19
Canadian Centre for Occupational Health and Safety. Workplace stress – General [Internet]. [place unknown]: Canadian Centre for Occupational Health and Safety; 2012 Jun 7 [cited 2013 Jul 8]. Available from: http://www.ccohs.ca/oshanswers/psychosocial/stress.html 20
Chau N, Choquet M, Falissard B, the Lorhandicap Group. Relationship of physical job demands to initiating smoking among working people: A population-based cross-sectional study. Industrial Health. 2009;47(3):319-325. 21
Smith DR. Workplace tobacco control: The nexus of public and occupational health. Public Health. 2009;123:817-819. 22
Katainen A. Social class differences in the accounts of smoking - striving for distinction? Sociology of Health & Illness. 2010;32(7):1087-1101.
111 Project Health – Tobacco-Free Living: What Works at Work!
23
Rodriguez D, Romer D, Audrain-McGovern J. Beliefs about the risks of smoking mediate the relationship between exposure to smoking and smoking. Psychosomatic Medicine. 2007;69:106-113. 24
Morris WR, Conrad KM, Marcantonio RJ, Marks BA, Ribisl KM. Do blue-collar workersperceive the worksite health climate differently than white-collar workers? American Journal of Health Promotion. 1999;13:319-324. 25
Westman M, Eden D, Shirom A. Job stress, cigarette smoking and cessation: the conditioning effects of peer support. Social Science & Medicine. 1985;20(6):637-644. 26
Barbeau EM, Goldman R, Roelofs C, Gagne J, Harden E, Conlan K, Stoddard A, Sorensen G. A new channel for health promotion: Building trade unions. American Journal of Health Promotion. 2005;19:297-303. 27
Health Canada. Canadian Tobacco Use Monitoring Survey [Internet]. [place unknown]: Health Canada; 2010 [cited 2013 Jul 10]. Available from: http://www.hc-sc.gc.ca/hc-ps/tobac-tabac/research-recherche/stat/index-eng.php 28
Christakis NA, Fowler JH. The collective dynamics of smoking in a large social network. New England Journal of Medicine. 2008;358:2249-2258. 29
Sorenson G, Barbeau E, Hunt M, Emmons K. Reducing social disparities in tobacco use: a social contextual model for reducing tobacco among blue-caller workers. American Journal of Public Health. 2004;94:230-239. 30
Lambraki I. Using incentives in workplace smoking cessation programs [Webinar]. Program Training and Consultation Centre and Propel Centre for Population Health Impact. 2013. Available from: https://www.ptcc-cfc.on.ca/common/pages/UserFile.aspx?fileId=258352 31
Van Osch L, Lechner L, Reubsaet A, Steenstra M, Wigger S, de Vries H. Optimizing the efficacy of smoking cessation contests; an exploration of determinants of successful quitting. Health Education Research. 2009;24:54-63 32
Howard J. Smoking is an occupational hazard. American Journal of Industrial Medicine. 2004;46(2):161-169. 33
Sorensen G, Barbeau E M, Staddard AM, Hunt MK, Goldman R, Smith A, Brennan AA, Wallance L. Tools for health: the efficacy of a tailored intervention targeted for construction labourers. Cancer Causes Control. 2007;18:51-59. 34
Hughes M, Yette E, Hannon P, Harris J, Tran N, Reid T. Promoting tobacco cessation via the workplace: opportunities for improvement. Tobacco Control. 2011;20(4):305-308. 35
Tiede LP, Hennrikus DJ, Cohen BB, Hilgers DL, Madsen R, Lando HA. Feasibility of promoting smoking cessation in small worksites: An exploratory study. Nicotine & Tobacco Research. 2006;9(Suppl 1):S83-S90.
112 Project Health – Tobacco-Free Living: What Works at Work!
4.3.2 Physical Work Environment
The physical environment can help or hinder smoking cessation in the
workplace. A supportive physical environment is one where all employees have
access to tobacco cessation information and support, and all workers are
protected from exposure to harmful second-hand smoke.
Definitions of Success
If smoking is allowed on company property, it is only allowed in a
Designated Smoking Area (DSA; also called a ‘smoking shelter’),
constructed outside specifically for that purpose and designed according
to the Smoke-Free Ontario Act requirements
Chemical and physical hazards are minimized and efforts are made to
reduce job related stress to show management commitment to the
health of employees
All employees are informed about and have access to workplace
cessation supports, regardless of their worksite, work schedule, or other
working conditions that could be a barrier
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Physical Work Environment The physical environment plays a role in supporting tobacco-free living among
all employees. Ensuring workplace hazards are minimized, implementing
restrictions on where tobacco use is allowed and working to reduce job related
stress, are all positive steps to show management is committed to employee
health. Every workplace has unique needs when it comes to addressing
employee tobacco use. Conduct a needs assessment to identify how your
physical workplace can be modified to support tobacco-free living. See the
Getting Started section for more information on conducting a needs
assessment.
Hazards
Minimizing exposure to physical or chemical workplace hazards is an important
step towards creating an environment that supports tobacco-free living.
Workers are less likely to engage in smoking cessation programming offered at
the workplace when management does not make efforts to reduce worker
exposure to job hazards.1
Physical hazards can impact both
mental and physical health,
leading to continued tobacco use.
For example, work in industries
such as construction is physically
demanding and involves
hazardous conditions such as
working at a height, in harsh
weather conditions, early or late in
the day, and over long periods of
time.2 These job demands affect job stress, and may lead to tobacco use or
continued use as a way to cope.3 For more information about job stress and how
this influences tobacco use, refer to the previous section, Organizational Culture.
Second-hand smoke is considered a chemical hazard as it is a known
carcinogen. The SFOA is intended to reduce worker exposure to harmful
second-hand smoke by making it illegal to hold lit tobacco and smoke in
enclosed workplaces. A further health benefit of reduced exposure to smoking
and second-hand smoke at the workplace is lower tobacco use among the
workforce overall.4 This occurs over time as smoking becomes less visible,
114 Project Health – Tobacco-Free Living: What Works at Work!
normal and acceptable at the
workplace, which in turn supports
workers who are trying to quit.
Workers in manual jobs, such as
mining, manufacturing,
construction, warehousing, and
transportation, tend to experience
higher levels of exposure to
second-hand smoke while working
compared to non-manual workers.2 An environment where exposure to second-
hand smoke and smoking is minimized or nonexistent protects workers and
supports employees who are trying to quit.
Creating a work environment where hazards, both chemical and physical, are
minimized, shows management commitment to the health of employees, which
can motivate smokers to reduce or quit smoking. Identify areas in your
workplace that could be improved and take steps to reduce exposure to
hazards. Communicate this with employees so they are also aware of positive
changes.
Places for Tobacco Use
When looking at where tobacco use is permitted on the physical grounds of the
workplace, complete tobacco bans, meaning tobacco use is not allowed
anywhere on company property, is the most effective policy option for lowering
exposure to second-hand smoke and reducing the number of employees who
smoke.5 However, complete tobacco bans are not realistic for some workplaces.
These workplaces could consider restricting tobacco use to a Designated
Smoking Area (DSA), also called a ‘smoking shelter’. However, some people
believe that having a DSA on company property makes quitting smoking more
difficult because it provides smokers with a place to smoke during breaks and
reinforces the social nature of smoking.2 The following sections discuss
considerations for specific types of employment. For more information about
complete tobacco bans, refer to the Policy Development section.
115 Project Health – Tobacco-Free Living: What Works at Work!
Considerations for Specific Types of Employment
Transient Work
Some employees work at various locations, away from a centralized workplace,
or work with other employers. Since they work at a distance, these employees
may be forgotten in wellness programming. The challenge is to ensure transient
workers are familiar with corporate and/or community tobacco cessation
supports such as self-help materials, extended health benefits, and applicable
workplace policies, and are provided with access to information and resources.
Refer to the Awareness Raising section for communication strategies to reach
transient workers with information and messaging.
SMALLER COMPANIES
Small companies may be more limited in their ability to provide tobacco
cessation programming or extended health benefits than large companies.6
Often employees are on contract, and wellness programs may not be seen as a
necessary item among these workers. Smaller companies can help workers by
linking them with supports and resources in the community. Investing in these
employees can have future implications as contract workers and those who are
self-employed may return to work for a company that has made efforts to help
its workers improve their health.6
Construction and Outdoor Work
In 2011, construction workers had the highest smoking
prevalence compared to other industries in Canada.7
Workers in construction have also been reported to
typically be heavier smokers than other workers.8 Many
workers in construction and trades work for smaller
companies, work on contract, or are self-employed,
which makes reaching these workers with traditional
workplace wellness programming challenging.6 These
workers may also be temporary, seasonal, or transient,
which adds further challenge to reaching the workers.
Outdoor workplaces can be particularly challenging venues in which to address
tobacco-free living. These workplaces are not specifically addressed in the
SFOA, which specifies no smoking allowed in enclosed workplaces. In these
cases, it is important to have a tobacco-use policy in place that clearly states
116 Project Health – Tobacco-Free Living: What Works at Work!
where employees can and cannot use tobacco. In addition to a written policy,
some workers have noted the importance of employers enforcing fines for
smoking where not allowed and/or tobacco-related litter.6 The next section,
Policy Development, offers help for creating a policy to support tobacco-free
living in a variety of workplaces.
Effective strategies to reduce tobacco use among outdoor workers have not yet
been identified, but using creative means to communicate health messages and
create a supportive environment for these workers will likely help.
Implementing and enforcing clear policies, providing access to self-help
resources at all job sites, providing in-house programming, and making referrals
to resources and services available in the community, is a good start towards
supporting these workers to be tobacco-free.
HAZARDS OF CONSTRUCTION WORK9
A Report of the US Surgeon General found that, compared to other workers:
Construction workers who smoke are 11 times more likely to develop
lung cancer;
Construction workers who work with asbestos are 5 times more likely
to develop lung cancer;
Construction workers who smoke AND work with asbestos are 50
times more likely to develop lung cancer.
Transportation
Workers in transportation have reported
experiencing higher levels of job stress
compared to other workers.10 The stress
experienced by bus drivers has been linked
directly to tobacco use.11 Stress experienced by
long haul truck drivers is related to physical
and psychological hazards on the job, such as
irregular work shifts, meal, and sleep times;
varying accommodations that can lead to sleep
disturbance; anxiety over traffic and schedules;
and financial strain.12-13 As mentioned in the
Organizational Culture section, this job stress is
closely related to an increase in employee
smoking, heavier smoking, and decreased quitting.10,14,15,16,17 18,19.20.
117 Project Health – Tobacco-Free Living: What Works at Work!
Very little evidence exists for addressing tobacco use among workers in
transportation. However, any effort to mitigate job stress and promote healthy
coping will be supportive of tobacco-free living for these individuals. It is
important to ensure workers are familiar with workplace tobacco policies, are
aware of available corporate or community tobacco cessation supports, and
have access to extended health benefits, appropriate self-help materials, and
counseling support, whether through an EAP provider or telephone or web-
based programming.
Service and Hospitality
Much service industry work requires shift work or late night work, may be
seasonal, and is customer-focused, all of which can lead to work-related stress.
These factors, in addition to other factors such as relatively low income (many
jobs pay minimum wage), and low educational status of workers (lower
educational attainment is associated with greater likelihood of smoking) likely
contribute to the high rate of tobacco use among these workers.2 In Ontario,
workers in restaurants and bars continue to be exposed to toxic second-hand
smoke on outdoor patios, which is not presently legislated by the SFOA.21 The
Ontario Tobacco Research Unit indicates that young adults who work in retail,
accommodations, and food industries should be specifically targeted with
tobacco-free living interventions.22
118 Project Health – Tobacco-Free Living: What Works at Work!
Workers in the service industry tend to be young and more than half are
female.21 Strategies to reduce rates of smoking may be slightly different for
workers that make up this sector than for smokers in other occupations. For
example, young workers may be more influenced by coworkers and normative
behavior. Service workers are also less likely to try to quit smoking compared to
others.23 As such, a smoke-free grounds policy, which makes it more difficult for
employees to smoke while working, could have a more significant impact on
smoking rates than other changes to the work environment.24
Service and hospitality workers may also be seasonal, temporary, or transient,
making them difficult to reach with wellness programming. The same
recommendations apply here as were described for outdoor and transient
workers:
Use varied methods to communicate health messages;
Include all workers in benefits plans that cover tobacco cessation aids;
Reduce unnecessary stress in the workplace;
Implement and enforce clear policies regarding tobacco use;
Ensure employees are aware of corporate and community tobacco
cessation supports; and
Provide access to counseling supports, through an EAP provider or
telephone or web-based programming.
119 Project Health – Tobacco-Free Living: What Works at Work!
References
1 Howard J. Smoking is an occupational hazard. American Journal of Industrial Medicine. 2004;46(2):161-
169. 2 Central East Tobacco Control Area Network. Literature review: Workplace cessation project. Ontario;
2012 Feb 24. 3 Chau N, Choquet M, Falissard B, the Lorhandicap Group. Relationship of physical job demands to
initiating smoking among working people: A population-based cross-sectional study. Industrial Health. 2009;47(3):319-325. 4 Chin DL, Hong O, Gillen M, Bates MN, Okechukwu CA. Cigarette smoking in building trades workers: The
impact of work environment. American Journal of Industrial Medicine. 2012;55(5):429-439. 5 Centres for Disease Control and Prevention. Tobacco-use cessation [Internet]. Atlanta (GA): Centres for
Disease Control and Prevention; 2012 Aug 30 [cited 2013 Jul 9]. Available from: http://www.cdc.gov/workplacehealthpromotion/implementation/topics/tobacco-use.html 6 Bondy SJ, Bercovitz KL. Non-smoking worksites in the residential construction sector: Using an online
forum to study perspectives and practices. Tobacco Control. 2011;20(3);189-195. 7 Stonebridge C, Bounajm, F. Smoking cessation and the workplace: Briefing 1 – Profile of tobacco smokers
in Canada [Internet]. Ottawa (ON): The Conference Board of Canada; 2013 April [cited 2013 June 7]. Available from: http://www.conferenceboard.ca/e-library/abstract.aspx?did=5422 8 Ham DC, Przybeck T, Strickland JR, Luke DA, Bierut LJ, Evanoff BA. Occupation and workplace policies
predict smoking behaviours: Analysis of national data from the current population survey. Journal of Occupational and Environmental Medicine / American College of Occupational and Environmental Medicine. 2011;53(11):1337-1345. 9 US Department of Health and Human Services, The health consequences of smoking – Cancer and
chronic lung disease in the workplace: Report of the Surgeon General. Rockville, (MD): Public Health Service, Office of Smoking and Health; 1985. 10
Hedberg GE, Jacobsson KA, Janlert R, Langedoen S. Risk indicators of ischemic heart disease among male professional drivers in Sweden. Scandanavian Journal of Work, Environment and Health. 1993;19:326-333. 11
Tse JLM, Flin, R, Mearns K. Bus driver well-being review: 50 years of research. Transportation Research Part F. 2006;9:89-114. 12
Robinson CF, Burnett CA. Truck drivers and heart disease in the United States, 1979-1990. American Journal of Industrial Medicine. 2005;47:113-119. 13
Sorensen G, Quintiliani L, Pereira L, Yang M, Stoddard A. Work experiences and tobacco use: Findings from the gear up for health study. Journal of Occupational and Environmental Medicine / American College of Occupational and Environmental Medicine. 2009;51(1):87-94. 14
Azagba S, Sharaf MF. The association between workplace smoking bans and self-perceived, work-related stress among smoking workers. BMC Public Health. 2012;12(123):1-8. 15
Sorenson G, Barbeau E, Hunt M, Emmons K. Reducing social disparities in tobacco use: a social contextual model for reducing tobacco among blue-caller workers. American Journal of Public Health. 2004;94:230-239. 16
Kuper H, Marmot M. Job strain, job demands, decision latitude, and risk of coronary heart disease within the Whitehall II study. Journal of Epidemiology and Community Health. 2003;57:147-153. 17
Kouvonen A, Kivimaki M, Virtanen M, Pentti J, Vahtera J. Work stress, smoking status, and smoking intensity: an observational study of 46 190 employees. Journal of Epidemiology & Community Health. 2005;59:63–69. 18
van’t Klooster, J. Smoking cessation in the workplace, what works: A literature review [Internet]. Wellington, (NZ): The Quit Group. 2009 [cited 2012 Jul 24]. Available from: http://www.quit.org.nz/file/research/FINAL%20smoking%20cessation%20in%20the%20workplace%20and%20what%20works%2020090529.pdf 19
Cunradi CB, Lipton R, Banerjee A. Occupational correlates of smoking among urban transit operators: a prospective study. Substance Abuse Treatment, Prevention, and Policy. 2007;2(36). 20
Pirrie M, McGrath H, Garcia JM, Lambraki I, Pieters K. Literature review: Workplace tobacco cessation initiatives for young adults. Waterloo, (ON): Propel Centre for Population Health Impact, University of Waterloo; 2012. 21
Health Canada. Workplace smoking: Trends, issues and strategies [Internet]. 2010 [cited 2012 Aug 31]. Available from: http://www.hc-sc.gc.ca/hc-ps/pubs/tobac-tabac/1996-work-travail/index-eng.php
120 Project Health – Tobacco-Free Living: What Works at Work!
22
Ontario Tobacco Research Unit. Indicators of Smoke-Free Ontario progress. Monitoring and evaluation series. Toronto (ON): Ontario Tobacco Research Unit, Special Report; 2010 Jan;14/15(2). 23
Alexander LA, Crawford T, Mendiondo MS. Occupational status, work-site cessation programs and policies and menthol smoking on quitting behaviours of US smokers. Addiction. 2010;105(Suppl 1):95-104. 24
Stich C, Garcia J. Analysis of the young adult Ontario workforce: Identifying points of intervention for smoking cessation within the young adult (age 20–34) workforce. [place unknown]: The Ontario Tobacco and Research Unit; 2011.
121 Project Health – Tobacco-Free Living: What Works at Work!
4.3.3 Extended Health Benefits for Tobacco-Free Living
Smoking can be a significant cost to employers in terms of smoking-related
medical expenses and lost productivity, as outlined in the Background section of
this toolkit.1 Providing adequate coverage for proven tobacco cessation aids has
been identified as the “single most cost-effective health insurance benefit for
adults that can be provided to employees,”2,3,4 and is an essential component of
tobacco-free living programming in the workplace. This section provides an
overview of what to include in a benefits plan to support employees in their
efforts to quit smoking.
Definitions of Success
Health benefits cover proven tobacco cessation aids: nicotine
replacement therapy (NRT), smoking cessation medications, and
cessation counseling
Lifetime maximums on smoking cessation health benefits are removed
to allow employees to make as many attempts as needed to quit
smoking
Proven cessation treatments are affordable, requiring minimal or no co-
payments to increase their use
Employees are aware of the cessation benefits offered to them
Benefits include family members to promote social support at home to
quit smoking
Employee Assistance Program (EAP) provides smoking cessation
support and employees are aware of how to access these services
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Comprehensive Benefits Plans Quite often, neither employees nor employers know what health benefits their
company offers for tobacco cessation, and in many cases employers are unsure
of what to ask health benefits providers to include in a benefits package.
Tobacco cessation treatments recommended by Health Canada that have
substantial evidence of effectiveness include:
Nicotine replacement therapy (NRT)
Prescription smoking cessation medications [bupropion hydrochloride
(Zyban) and varenicline tartrate (Champix)]
Individual counseling
Approximately 2 per cent – 5 per cent of individuals who try to quit smoking on
their own succeed.5 This percentage can increase to 16 per cent when assistance
is provided.6 Use of smoking cessation medications, NRT, and counseling are
two to three times more effective at increasing the likelihood of successful
quitting compared to the use of self-help methods.7,8,9 Further, NRT or smoking
cessation medications are more effective when used in combination with
individual or group counseling and self-help resources such as booklets,
telephone, and web-based programs.10 Benefits coverage for these treatment
options increases the likelihood that employees will use them and also increases
the number of successful quit attempts made.11 Extended health benefits may
also provide coverage for other paramedical services which employees may
chose to use when making a quit attempt; however these methods have not
been proven to be effective for smoking cessation. See the following table for a
list of these services.
UNPROVEN Quit-Smoking Methods12
Although some people might quit successfully by using the following methods,
there is not enough scientific evidence to show that they are effective at
helping people to quit smoking:
Acupuncture
Acupressure
Electrostimulation
Laser therapy
Hypnosis
123 Project Health – Tobacco-Free Living: What Works at Work!
The Canadian Lung Association recommends that individuals who are trying to
quit choose two or more proven quit-smoking methods to increase their
chances of success.12 See the following table for proven quit-smoking methods.
PROVEN Quit-Smoking Methods12
Support groups – people in quit groups are more likely to stay quit.
Individual counseling, in person or by phone – use Smokers’ Helpline, or ask
your doctor to recommend an in-person counselor. A counselor may be
covered by your extended health plan or provided through an Employee
Assistance Program.
Nicotine replacement therapy (NRT) – NRT comes in many forms (patch,
gum, lozenge, inhaler or mist). NRT works to replace some of the nicotine
smokers would normally get from cigarettes and can therefore reduce nicotine
withdrawal symptoms allowing the individual time to practice new behaviours
to manage trigger situations and learn coping strategies to remain smoke-free.
Prescription medications – bupropion, varenicline tartrate – ask your doctor
about whether either of these may be appropriate for you. Bupropion is an
antidepressant that can make quitting easier. Varenicline tartrate can reduce
withdrawal symptoms and cravings and reduce the pleasurable effects of
smoking.
Keep trying! – It can take many quit attempts before a smoker is able to quit
for good. Keep trying until this happens!
Ask for support from family and friends
Cold-turkey – some people successfully quit by one day stopping all smoking.
If you think this could work for you, give it a try!
The Canadian Lung Association provides useful information about NRT and
medications (http://www.lung.ca/protect-protegez/tobacco-
tabagisme/quitting-cesser/medications-medicaments_e.php), including how
these should be used and common misconceptions about them. Some
information on NRT and smoking cessation medications is provided next. For
more information, refer employees to their health care provider or pharmacist.
124 Project Health – Tobacco-Free Living: What Works at Work!
Nicotine Replacement Therapy (NRT)
NRT is the most commonly used pharmacological treatment for smoking
cessation.13 However, research with a sample of workplaces in the mining,
manufacturing, forestry, service, and transportation industries in Ontario found
that only half offered benefits coverage for NRT.14 This is reportedly because a
prescription is not needed, and employers were unaware of the benefits and
barriers of NRT use.14 Ensuring NRT is covered as part of a benefits plan is
especially important for workplaces where employees may not be able to easily
afford NRT on their own.
NRT provides the body with nicotine (the addictive component of tobacco use)
in a safe manner without the other 4, 000 harmful chemicals contained in
tobacco smoke.12 NRT partially replaces the nicotine normally obtained from
cigarettes, which can help reduce cravings and nicotine withdrawal symptoms
associated with quitting smoking.12 Through the use of NRT employees can
practice new coping behaviours and skills to manage stress, cravings, and
trigger situations. Systematic reviews show that all forms of NRT increase quit
rates at 12 months by approximately 1.5 - 2 times compared with a placebo
regardless of the setting.12 NRT is available in different strengths without a
prescription in Canada and comes in the following forms: patch, gum, lozenge,
inhaler, and mist. NRT costs approximately $30 for a week’s supply15 and may
cost more, depending on type. These costs may be a significant barrier for low-
income individuals who tend to have high smoking rates and low quit rates.16
Nicotine withdrawal symptoms that may be reduced by NRT:7
Anger Anxiety
Cravings Difficulty concentrating
Hunger Impatience
Restlessness
See Dealing with Nicotine Withdrawal in the Appendix of this toolkit for
suggestions on how to deal with withdrawal symptoms.
NRT is often overlooked by people trying to quit. Some consider it to be too
expensive, to produce negative side-effects, or incorrectly believe it to be
ineffective.17 NRT has been shown to increase the effectiveness of workplace
cessation programs by 10 per cent,18 therefore it is prudent for workplaces to
ensure employees are aware of the myths and facts associated with NRT and
have access to it.
125 Project Health – Tobacco-Free Living: What Works at Work!
The Centre for Addiction and Mental Health provides a useful chart highlighting
the myths and facts of using nicotine replacement therapies and other
medications to stop smoking19 that can be found at:
http://knowledgex.camh.net/primary_care/toolkits/addiction_toolkit/smoking/P
ages/patient_information.aspx
Bupropion Hydrochloride (brand name Zyban)
Bupropion is one of two non nicotine-based medications used to help people
quit smoking and was originally developed as an antidepressant.20 It aids quit
attempts by alleviating cravings associated with nicotine withdrawal. Bupropion
now has over ten years of study and has been shown to double quit rates when
compared with unaided quit attempts.7,21,22 Bupropion requires a prescription
from a physician, nurse practitioner, or pharmacist and is contraindicated in
some individuals, so employees should be encouraged to speak with their health
care provider about their eligibility.
Varenicline Tartrate (brand name Champix)
Varenicline is the other non nicotine-based smoking cessation medication. It
acts to reduce cravings for cigarettes so quitting is made easier, and to decrease
the pleasurable effects of smoking. Studies to date have shown a two-three fold
increase in quit rates with the use of varenicline when compared to unaided quit
attempts.23 Just like bupropion, varenicline requires a prescription from a
physician, nurse practitioner, or pharmacist and is not right for everyone, so
employees should be encouraged to speak with their health care provider about
their eligibility.
Individual Counseling
Unassisted quit attempts are only successful 3-5 per cent of the time, compared
with up to 20 per cent success for those receiving cessation counseling and
medications.24 Individual cessation counseling, whether delivered in-person or
on the phone, is more effective than either self-help or education-only cessation
approaches. Consider the following when offering counseling:
Smokers are more likely to use telephone counseling than to participate
in individual or group counseling.7 ,25 Telephone counseling may be
particularly useful when trying to reach difficult-to-reach workers, such
as those that work away from a central workplace.26
126 Project Health – Tobacco-Free Living: What Works at Work!
When possible, offer four or more counseling sessions as there is a strong
dose-response relationship between counseling session length and
successful quit attempts.27
Workplaces should strive to offer both counseling and smoking cessation
medications/NRT, as the combination of both is more effective than
either one alone.26
Refer to the next section, Comprehensive Cessation Programming, for more
information on what to offer employees in terms of smoking cessation
counseling.
If your workplace has an on-site health professional who regularly interacts with
employees, they should be trained to follow the “5 A’s model” for smoking
cessation. The 5 A’s Model is a brief intervention recommended by the Canadian
Action Network for the Advancement, Dissemination and Adoption of Practice-
informed Tobacco Treatment (CAN-ADAPTT). Brief interventions from a health
care provider, lasting less than three minutes have been proven to increase
overall quit rates.27 As mentioned earlier, the effectiveness of cessation
counseling increases as the number and length of sessions increases,7,27,28 but
even if counseling is brief, it is useful.8 For more information about the 5 A’s
model including information, training, and resources, visit the You Can Make It
Happen website: http://youcanmakeithappen.ca/.
127 Project Health – Tobacco-Free Living: What Works at Work!
5 A’s Model27
Ask – patients about smoking status
Advise – patients about the health risks of tobacco use and to quit
Assess – patients’ readiness to quit
Assist – patients that are ready to quit
Arrange – follow up
Coverage Variance Group benefits plans vary widely based on the organization and type of
employees. The Conference Board of Canada surveyed Canadian organizations
in January of 2013 to find out what most organizations offer in terms of
workplace programs and policies to help employees quit smoking. The following
is a summary of the findings on health benefits coverage of smoking cessation
aids and services:29
Most employers (78 per cent) provide psychological sessions/counseling
through an Employee Assistance Program (EAP)
Most employers provide coverage of prescription smoking cessation
medications Champix and Zyban (73 per cent); however, these
prescriptions drug plans often have yearly (16 per cent) or lifetime (48
per cent) maximums
Only 40 per cent of organizations’ benefits plans provide coverage of
NRT. Of these, 31 per cent have a yearly maximum and 38 per cent a
lifetime maximum
Psychological sessions/counseling and alternative therapies such as
hypnosis or acupuncture were covered by approximately 40 per cent of
organizations. However, in many cases treatments are covered only if it
is considered an eligible paramedical expense. Organizations may
choose to have separate maximums for each paramedical service (e.g.
psychologist, physiotherapy, chiropractor) or a combined maximum for
all paramedical services
Some organizations did not explicitly cover smoking cessation aids
through their group benefits plan but instead offered a health care
spending account that could be used to claim these expenses
128 Project Health – Tobacco-Free Living: What Works at Work!
Access to benefits plans varies by type of work. While almost all permanent full-
time employees (98 per cent) are covered by a group benefits plan, only 74 per
cent of permanent part-time and 23 per cent of non-permanent employees
(such as those on contract or term) reported coverage.29 These types of
employees tend to work in construction, trades, or service, and may experience
relatively low income, putting them at greater risk of using tobacco. Benefits
coverage for these workers is important so they may access cessation supports.
Providing benefits coverage for tobacco cessation has been shown to be either
cost-effective or neutral for workplaces.2 Generally, costs equalize with
expenditures at three years, and benefits exceed costs by five years.2
Unfortunately most tobacco users are not aware of the benefits offered to them
at work, and as a result do not make use of them.30
What to include in a group benefits plan
The Center for Disease Control’s Community Preventive Services Task Force in
the US recommends that health insurers provide the following coverage for
tobacco cessation as part of health benefits:31
Cover at least four counseling sessions of at least 30 minutes each, including
proactive telephone counseling and individual counseling. While classes are
also effective, few smokers attend them
Cover both prescription medications and over-the-counter nicotine
replacement therapy
Provide counseling and medication coverage for at least two smoking
cessation attempts per year
Eliminate or minimize co-pays or deductibles for counseling and
medications, as even small co-payments reduce the use of proven
treatments
Ensuring health benefits provide adequate coverage for proven cessation aids is
important for long-term cessation success. Take the time to communicate with
benefits providers and ask for comprehensive tobacco benefits coverage for
employees. Occupations with higher smoking rates tend to employ workers of
lower incomes who may require benefits coverage to obtain access to quit aids.
129 Project Health – Tobacco-Free Living: What Works at Work!
References
1 Centre for Disease Prevention and Control. Benefits summary [Internet]. [place unknown]: Centres for
Disease Prevention and Control; 2009 [cited 2013 May 3]. Available from: http://www.cdc.gov/tobacco/quit_smoking/cessation/coverage/page1/ 2 Warner KE. Cost effectiveness of smoking-cessation therapies. Interpretation of the evidence and
implications for coverage. Pharmacoeconomics. 1997;11(6):538–49. 3 Cummings SR, Rubin SM, Oster G. The cost-effectiveness of counseling smokers to quit. Journal of the
American Medical Association. 1989;261(1):75–79. 4 Coffield AB, Maciosek MV, McGinnis JM, Harris JR, Caldwell MB, Teutsch SM, Atkins D, Richland JH,
Haddix A. Priorities among recommended clinical preventive services. American Journal of Preventive Medicine. 2001;21(1):1–9. 5 West R. Background smoking cessation rates in England [Internet]. 2006 [cited 2013 Mar 25]. Available
from: www.smokinginengland.info/Ref/paper2.pdf 6 Berry JK, Corbridge SJ. Smoking cessation – Part II: counselling in the workplace. Journal of the American
Association of Occupational Health Nurses. 2005;53(5):194-197. 7 Fiore M, Jaen CR, Baker TB, Bailey WC, Benowitz N, Curry SJ. Treating tobacco use and dependence: 2008
update. Rockville (MD): U.S. Department of Health and Human Services, Public Health Service; 2008 May:257. 8 Ranney L, Melvin C, Lux L, McClain E, Lohr KN. Systematic review: Smoking cessation intervention
strategies for adults and adults in special populations. Annals of Internal Medicine. 2006;145(11):845-856. 9 Cahill K, Moher M, Lancaster T. Workplace interventions for smoking cessation. Cochrane Database of
Systematic Reviews. 2008;(4):CD003440. 10
Health Canada. Quit smoking aids [Internet]. [place unknown]: Health Canada; 2011 [cited 2013 May 8]. Available from: http://www.hc-sc.gc.ca/hc-ps/tobac-tabac/body-corps/aid-eng.php 11
Centres for Disease Control and Prevention. Tobacco-use cessation [Internet]. Atlanta (GA): Centres for Disease Control and Prevention; 2012 Aug 30 [cited 2013 Jul 9]. Available from: http://www.cdc.gov/workplacehealthpromotion/implementation/topics/tobacco-use.html 12
The Canadian Lung Association. Smoking & tobacco [Internet]. [place unknown]: The Canadian Lung Association; 2012 Sept 24 [cited 2013 Jul 12]. Available from: https://www.lung.ca/protect-protegez/tobacco-tabagisme/quitting-cesser/how-comment_e.php#proven 13
Registered Nurses’ Association of Ontario. Integrating smoking cessation into daily nursing practice. Nursing best practice guideline: Shaping the future of nursing. Toronto (ON): Registered Nurses’ Association of Ontario; 2007. 14
Northwest Tobacco Control Area Network. Worksite cessation project. [place unknown]: Northwest Tobacco Control Area Network; 2012. 15
Ontario Medical Association. Rethinking stop-smoking medications: treatment myths and medical realities [Internet]. Toronto (ON): Ontario Medical Association; 2008 Jan [cited 2013 Jul 9]. Available at: https://www.oma.org/resources/documents/e2008rethinkingstop-smokingmedications.pdf 16
Shiffman S, Gitchell J, Pinney JM, Burton SL, Kemper KE, Lara EA. Public health benefit of over-the counter nicotine medications. Tob Control. 1997 Winter;6(4):306-10. 17
Tiede LP, Hennrikus DJ, Cohen BB, Hilgers DL, Madsen R, Lando HA. Feasibility of promoting smoking cessation in small worksites: An exploratory study. Nicotine & Tobacco Research. 2006;9(Suppl 1):S83-S90. 18
Osinubi O, Moline J, Rovner E, Sinha S, Perez-Lugo M, Demisse K, Kipen HM. A pilot study of telephone-based smoking cessation intervention in asbestos workers. Journal of Occupational and Environmental Medicine. 2003;45(5):569-574. 19
Myths and facts of using nicotine replacement therapies and other medications to stop smoking. [place unknown]: Centre for Addiction and Mental Health; date unknown [cited 2013 Apr 26]. Available from: http://knowledgex.camh.net/primary_care/toolkits/addiction_toolkit/smoking/Documents/Toolkit-Myths_Facts_NRT.pdf 20
Program Training and Consultation Centre. How to make your workplace tobacco-free: A toolkit for the development of a tobacco control policy at the workplace [Internet]. date unknown [cited 2013 May 22]. Available from: https://www.ptcc-cfc.on.ca/common/pages/UserFile.aspx?fileId=104468 21
Wu P, Wilson K, Dimoulas P, Mills EJ. Effectiveness of smoking cessation therapies: a systematic review and meta-analysis. BMC Public Health. 2006;6:300. 22
Hughes JR, Stead LF, Lancaster T. Antidepressants for smoking cessation. Cochrane Database of Systematic Reviews. 2007;1:Art No. CD000031.
130 Project Health – Tobacco-Free Living: What Works at Work!
23
Cahill K, Stead LF, Lancaster T. Nicotine receptor partial agonists for smoking cessation. Cochrane Database of Systematic Reviews, 2011;2:Art No. CD006103. 24
Why make it happen? [Internet]. [place unknown]: You Can Make it Happen. Date unknown [cited 2013 Jul 12]. Available from: http://youcanmakeithappen.ca/ 25
McAfee T. Increasing the population impact of quitlines. Paper presented at the North American Quitline Conference, Phoenix, AZ, 2002. 26
Sorensen G, Barbeau E M, Staddard AM, Hunt MK, Goldman R, Smith A, Brennan AA, Wallance L. Tools for health: the efficacy of a tailored intervention targeted for construction labourers. Cancer Causes Control. 2007;18:51-59. 27
CAN-ADAPTT. Canadian smoking cessation clinical practice guideline. Toronto (ON): Canadian Action Network for the Advancement, Dissemination and Adoption of Practice-informed Tobacco Treatment, Centre for Addiction and Mental Health; 2011. 28
Piasecki TM. Relapse to smoking. Clinical Psychology Review. 2006;26:196-215. 29
Lamontagne E, Stonebridge C. Smoking cessation and the workplace: Briefing 2 – Smoking cessation programs in Canadian workplaces [Internet]. Ottawa, (ON): The Conference Board of Canada; 2013 June [cited 2013 June 28]. Available from: http://www.conferenceboard.ca/e-library/abstract.aspx?did=5565 30
Musich S, Chapman LS, Ozminkowski R. Best practices for smoking cessation: Implications for employer-based programs. The Art of Health Promotion. 2009;Sept/Oct:1-10. 31
Centre for Disease Prevention and Control. Benefits summary [Internet]. [place unknown]: Centres for Disease Prevention and Control; 2009 [cited 2013 May 3]. Available from: http://www.cdc.gov/tobacco/quit_smoking/cessation/coverage/page1/
131 Project Health – Tobacco-Free Living: What Works at Work!
4.3.4 Comprehensive Cessation Programming
In addition to creating smoke-free policies and changing the environment to
support employees to stop using tobacco, offering cessation programming in
the workplace provides the most comprehensive approach to support tobacco-
free living. Cessation programming may differ from workplace to workplace, but
should include the provision of tobacco use cessation counseling, either
individual or group based.1-2 As mentioned in previous sections, if workplaces do
not have sufficient resources to offer smoking cessation programming through
the workplace, employers can refer employees to smoking cessation counseling
services in the community. For more information on resources available in your
community, visit the Smoker’s Helpline website at
http://info.cancer.ca/e/shl/shlsearch.asp and search with your postal code.
Definitions of Success
Self-help materials are readily available for employees
Group cessation classes and/or individual counseling is provided in the
workplace, and/or links are made for employees to access such activities
in the community
Employees have access to a trained cessation counselor, either in the
workplace, through an Employee Assistance Program (EAP) provider, or
other accessible support
If employees work at various locations or on various shifts, telephone
counselling is offered by a qualified cessation counselor
4.4
Su
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ortive
En
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nt
4.3 S
up
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en
t
132 Project Health – Tobacco-Free Living: What Works at Work!
Comprehensive Cessation Programming
Employers are sometimes unsure about how to support their employees to live
tobacco-free and may be hesitant about their role. Employers tend to feel more
comfortable providing wellness resources for employees in a passive way, such
as posting information on bulletin boards or providing self-help materials for
employees to access themselves.3 However, employees prefer more active
wellness interventions such as those that use contests, incentives, and provide
NRT.3 These active methods of engagement will have a greater effect on
employee health and wellness than will passive methods.
Offering programs and
services at the workplace
sends a strong message
of management
commitment and support
for employee health and
well-being, can help
target hard-to-reach
employees (i.e., those
that work irregular shifts
and at off-site locations),
and allows for follow-up
support, which is particularly important for smoking cessation.1
Research shows that workplaces such as office environments are more likely to
offer smoking cessation programming than those where workers mostly work in
manual jobs.4-5 Workplaces that do not offer cessation programming have been
found to have workers who are more persistent smokers and have lower
intention to quit.4,5 Despite higher rates of smoking at some workplaces,
workers in general – both smokers and non-smokers – want to quit smoking and
reduce environmental tobacco smoke in the workplace.6-7
Not having a workplace cessation program has been described as one reason
why some workplaces experience higher rates of smoking compared to others.5
Some workers, particularly those in occupations such as manufacturing, mining,
construction and trades, transportation, and warehousing, tend to be unaware
of what proven tobacco treatments are, and are less likely to use them.8
Offering cessation activities in the workplace can educate workers on available
smoking cessation supports and encourage smokers, particularly moderate and
heavy smokers, to quit.9 Creating a supportive physical and social environment
will help workers who smoke access and utilize quit aids.
133 Project Health – Tobacco-Free Living: What Works at Work!
Smoking Cessation Clinical Practice Guidelines The Canadian Action Network for the Advancement, Dissemination and
Adoption of Practice-informed Tobacco Treatment (CAN-ADAPTT) has
identified Canadian Smoking Cessation Clinical Practice Guidelines to inform
evidence-based smoking cessation care in Canada. Consider these evidence-
based guidelines when planning tobacco-free living programming in the
workplace that include counseling and psychosocial approaches:10
Minimal interventions, of one to three minutes (such as those offered
during workplace HRAs), are effective and should be offered to every
tobacco user. There is a strong dose-response relationship between the
session length and successful treatment, so whenever possible, intensive
interventions should be used.
Counseling by a variety or combination of delivery formats (self-help,
individual, group, telephone helpline, web-based) is effective and should
be used to assist individuals who express a willingness to quit.
Because multiple counseling sessions increase the chances of prolonged
abstinence, health care providers should provide four or more counseling
sessions where feasible.
Combining counseling and smoking cessation medication is more
effective than either alone, therefore both should be provided to
individuals trying to stop smoking where possible. Unassisted quit
attempts are successful only 3-5 per cent of the time, compared with up
to 20 per cent success for those receiving cessation counseling and
medications.11
Two types of counseling and behavioural therapies yield significantly
higher abstinence rates and should be included in smoking cessation
treatment: 1) providing practical counseling on problem solving skills or
skills training; and 2) providing social support as part of treatment.
134 Project Health – Tobacco-Free Living: What Works at Work!
Levels of Support the Workplace May Provide There are three levels of support for tobacco cessation programming that
workplaces may provide:1,2
1. Comprehensive – tobacco cessation benefits are fully-covered,
cessation programming is provided on-site
2. Facilitative – extensive information is provided to employees, including
self-help materials and a listing of programs and services in the
community; outside agencies are invited to provide some cessation
services
3. Referral-based – information is provided and employees are referred to
community-based programs and materials
To achieve the greatest impact, the Canadian Centre for Occupational Health
and Safety (CCOHS) recommends that all three approaches be employed. For
an overview of the pros and cons of each approach, please see Smoking
Cessation in the Workplace: Comparing the Different Approaches, located in the
Appendix.
Workplaces can determine which level of support best fits both their employees’
needs and their organizational constraints by first completing a needs
assessment and/or Health Risk Assessment (HRA) (see the Getting Started
section). Health Risk Assessments are a great way to establish employees’
health needs and identify problems to address.12 Workplaces can use Health
Risk Assessments to examine smoking habits and risks to gain a better
understanding of the number of smokers in the workforce and their motivations
to quit.12 Workplaces can develop specific needs assessment tools to evaluate
employees’ reasons for smoking, methods of quitting tried in the past, readiness
to make a quit attempt, interest in using smoking cessation medications or NRT,
and type of cessation support preferred (on-site programming, individual,
group, telephone, web-based counseling, etc.). Workplaces can then use this
valuable information to guide program planning. Additionally, health
improvements can be tracked by looking at trends in the HRA responses over
time which can provide important evaluation feedback on the effectiveness of
comprehensive tobacco cessation programming.12
135 Project Health – Tobacco-Free Living: What Works at Work!
The following is a list of suggestions workplaces may consider when planning
the type of comprehensive tobacco cessation programming most appropriate
for their employees and specific workplace:13
Provide free smoking cessation brochures and self-help materials in
areas where employees can help themselves;
Use employee newsletters and intranets to communicate the
importance of quitting smoking and the resources and benefits coverage
available to employees;
Invite guest speakers from the community, such as local health care
providers, to speak about quitting smoking;
Look into telephone-based counseling programs that may be accessed
by employees; consider adopting a policy that allows employees to
access these services during work hours;
Offer access to online smoking cessation counseling and information,
and develop a policy that allows employees to participate during breaks
or work hours. Engage providers who focus exclusively on smoking
cessation as well as those who offer cessation counseling as part of a
broader array of services (e.g. Employee Assistance Programs);
Train existing on-site medical personnel (e.g., occupational health
nurses, physicians assistants, physicians) in smoking cessation
counseling and in the referral resources available in the community;
Train internal health promotion, fitness, and Employee Assistance
Program personnel to ask about smoking and refer employees to
smoking cessation services and benefits;
Develop an incentive system to promote participation in workplace
smoking cessation programming;
Ensure low or non-existent co-pays on smoking cessation medications
and NRT, as research indicates very low or no co-pays to be the best way
to encourage people to quit smoking;14
Sponsor an on-site support group for those attempting to quit and
recent quitters working to maintain tobacco-free status;
Conduct a brief one-session seminar to attract “fence straddlers” and
offer refreshments or a free lunch. Invite an employee who is an ex-
smoker to speak;
Sponsor a special event that includes a focus on smoking cessation, such
as a health fair;
136 Project Health – Tobacco-Free Living: What Works at Work!
Sponsor a confidential HRA for all employees – this may be accompanied
by physical health tests such as a blood pressure and carbon monoxide
testing to provide employees with a measure of their health status and
education on ways to improve their health;
Sponsor subsidized on-site or community-based smoking cessation
counselling. Consider opening the class to spouses and other family
members; and
Recommend public web sites that provide information, counselling, and
support for smoking cessation, and consider providing time during the
work day for employees to access the internet for smoking cessation
information.
Some smokers are more motivated by one approach than another, so providing
a range of strategies is important in the workplace.2 It is important to offer
counseling in combination with smoking cessation medications and/or NRT, as
this results in more successful quitting.2
If you are able to provide cessation programming at work, there are many
resources available to help. Visit the Project Health website at
http://www.projecthealth.ca/project-health-topics/tobacco-free-living for a list
of reputable websites that have helpful information on tobacco-free living. The
following checklist may be helpful when choosing or developing in-house
smoking cessation programming:
137 Project Health – Tobacco-Free Living: What Works at Work!
Adapted from: Smoking Cessation in the Workplace: A guide to helping your employees quit
smoking, Health Canada, 2008
Check list for assessing smoking cessation programs
❑Can the program be offered at times and in locations that are convenient for employees?
❑Will the program suit employees’ personalities and styles of learning?
❑Do program leaders recognize that not all smokers are at the same stage in the quitting process? Can they modify their approach accordingly?
❑Has the program been evaluated and does it have a proven success rate based on a thorough three-and six-month follow-up?
❑Is the program offered by or associated with a credible organization?
❑Is there sufficient follow-up and support?
Consider asking the following questions about program content and its leaders (the more “yes” answers the better). Does the program:
❑Help the smoker deal with the physical addiction of smoking?
❑Incorporate the use of quit medications?
❑Help the smoker deal with the psychological addiction of smoking?
❑Help the smoker deal with the social nature of smoking?
❑Prepare the smoker for a future without cigarettes?
❑Reinforce the smoker’s motivation to quit?
❑Provide tips to control urges to smoke?
❑Make use of the special support systems and other wellness activities in the workplace?
❑Provide information about stress management, physical activity and nutrition?
Are the program leaders:
❑Knowledgeable about behaviour change in general and smoking cessation in particular?
❑Supportive and genuinely interested in helping people quit smoking?
Check references. Call other organizations, ask about the program and speak with people who have participated in the program.
138 Project Health – Tobacco-Free Living: What Works at Work!
Comprehensive Workplace Cessation Programming
In the ideal world, workplaces could meet the recommendations previously
outlined by providing the following on-site to employees to promote tobacco-
free living:2,15
Individual cessation counseling (four or more sessions)
Group counseling or classes that provide two types of counseling:
1. practical counseling to teach smokers about what to expect from
a quit attempt, how medications work, and what side effects
might be expected, how to prepare for and manage trigger
situations, cravings, and withdrawal symptoms
2. important social support throughout the process
Counseling by a variety of methods including: proactive telephone
counseling to engage smokers, and/or access to a telephone quitline;
informational and self-help materials; and web-based programming
Benefits coverage for and effective promotion of smoking cessation
medications and NRT
Referrals to healthcare providers, cessation programs, and other sources
of information in the community
Support for buddy systems and other supportive relationships in the
workplace
Not every workplace is able to provide such comprehensive programming, and
it is up to each workplace to identify what strategies will work best in their
environment to meet the needs of their employees.
139 Project Health – Tobacco-Free Living: What Works at Work!
The Conference Board of Canada’s survey of Canadian organizations in January
2013 asked about smoking cessation programs and found:12
Two thirds of organizations (63 per cent) had a smoking cessation
program in place for all (27 per cent) or some (36 per cent) of their
employees
Smoking cessation programs were significantly more common in the
public sector (78 per cent) than in the private sector (57 per cent)
Large organizations (with more than 5,000 employees) were the most
likely to offer smoking cessation programs
For almost half of organizations surveyed, the smoking cessation
program was administered by an external third party; only 27 per cent
administered the program internally, and 28 per cent co-managed the
program with an external provider
Organizations most frequently outsourced the administration of their
smoking cessation program to an EAP provider
Some organizations partnered with groups, such as provincial lung
associations, to administer smoking cessation programs
For small companies that lack the resources or capacity to deliver a smoking
cessation program, partnering with external organizations can be a valuable
way to facilitate employee access to programming. In all cases, care should be
taken to ensure programming is not provided for just a short duration – once the
program is finished, employees may no longer have supports in place that are
needed to maintain a quit attempt.
140 Project Health – Tobacco-Free Living: What Works at Work!
References
1 Canadian Centre for Occupational Health & Safety. Environmental tobacco smoke (ETS): Workplace
policy [Internet]. 2011 [cited 2013 Jan 27]. Available from: www.ccohs.ca 2 Global Smokefree Partnership [Internet]. [place unknown]: Designing a 100% smokefree workplace
policy. Global Smokefree Partnership; date unknown [cited 2013 May 28]. Available from http://www.globalsmokefreepartnership.org/ficheiro/18.pdf 3 Tiede LP, Hennrikus DJ, Cohen BB, Hilgers DL, Madsen R, Lando HA. Feasibility of promoting smoking
cessation in small worksites: An exploratory study. Nicotine & Tobacco Research. 2006;9(Suppl 1):S83-S90. 4 Alexander LA, Crawford T, Mendiondo MS. Occupational status, work-site cessation programs and
policies and menthol smoking on quitting behaviours of US smokers. Addiction. 2010;105(Suppl 1):95-104. 5 Ham DC, Przybeck T, Strickland JR, Luke DA, Bierut LJ, Evanoff BA. Occupation and workplace policies
predict smoking behaviours: Analysis of national data from the current population survey. Journal of Occupational and Environmental Medicine / American College of Occupational and Environmental Medicine. 2011;53(11):1337-1345. 6 Mitchell RJ, Weisman SR, Jones RM, Erickson D. The role of labor organizations in tobacco control: What
do unionized workers think? American Journal of Health Promotion. 2009;23(3):182-186. 7 Fronzi L, Haughey K. Creating a supportive environment: smoke-free policy & cessation support
[PowerPoint slides]. Brant County Health Unit; 2007. 8 Duffy SA, Ronis DL, Richardson C, Waltje AH, Ewing LA, Noonan D, Hong O, Meeker JD. Protocol of a
randomized controlled trial of the Tobacco Tactics website for operating engineers. BMC Public Health. 2012;12:335-345. 9 Kouvonen A, Kivimaki M, Oksanen T, Pentti J, Heponiemi T, Vaananem A, Virtanen M, Vahtera J.
Implementation of workplace-based smoking cessation support activities and smoking cessation among employees: The Finnish Public Sector Study. American Journal of Public Health. 2012;102(7):56-62. 10
CAN-ADAPTT. Canadian smoking cessation clinical practice guideline. Toronto (ON): Canadian Action Network for the Advancement, Dissemination and Adoption of Practice-informed Tobacco Treatment, Centre for Addiction and Mental Health; 2011. 11
You Can Make It Happen. Why make it happen? [Internet]. [place unknown]: You Can Make It Happen; 2011 [cited 2013 Jul 22]. Available from: http://youcanmakeithappen.ca/?page_id=91 12
Lamontagne E, Stonebridge C. Smoking cessation and the workplace: Briefing 2 – Smoking cessation programs in Canadian workplaces [Internet]. Ottawa, (ON): The Conference Board of Canada; 2013 June [cited 2013 June 28]. Available from: http://www.conferenceboard.ca/e-library/abstract.aspx?did=5565 13
Professional Assisted Cessation Therapy. Employers’ smoking cessation guide: Practical approaches to a costly workplace problem, second edition [Internet]. Hackensack (NJ): PACT; date unknown [cited 2013 Mar 7]. Available from: http://endsmoking.org/resources/employersguide/pdf/employersguide-2nd-edition.pdf 14
Solanki G, Schauffler HH, Miller LS. The direct and indirect effects of cost-sharing on the use of preventive services. Health Serv Res. 2000;34(6):1331-1350. 15
Musich S, Chapman LS, Ozminkowski R. Best practices for smoking cessation: Implications for employer-based programs. The Art of Health Promotion. 2009;Sept/Oct:1-10.
141 Project Health – Tobacco-Free Living: What Works at Work!
Policy Development
Workplace policy can have a significant influence on employee tobacco use
behaviour. A policy is a formal, written statement that helps clarify roles and
expectations of management and employees. A well written policy is
consistent with the values of the organization, ensures consistency in
decision-making, fosters sustainability, and clarifies functions and
responsibilities.1 It clearly defines acceptable and unacceptable behaviour
and explicitly states the implications of not following the policy.
Health related policies demonstrate a formal commitment to the health of a
company’s employees.2 The policy sends the message that, as employers,
the company acknowledges the vital link between their employees’ well
being and the organization’s success. Policy implementation is not the only
solution to promoting tobacco-free living at work, and for some it may not
be the best solution or the right time to implement a policy. However,
research clearly indicates that policies that restrict tobacco use at work are
effective at increasing and sustaining quit efforts, and help to create
healthier working environments.
Definitions of Success
Written policies are developed, communicated, monitored, and enforced
for all areas in the workplace that may influence tobacco use. This
includes policies that support workplace tobacco-free living initiatives
such as awareness raising, skill building activities, and supportive
environment strategies.
4.4
Po
licy D
eve
lop
me
nt
142 Project Health – Tobacco-Free Living: What Works at Work!
Policy Development
A policy is most effective when it supports other elements of a
comprehensive tobacco-free living strategy in the workplace (i.e., awareness
raising, skill building, and supportive environment initiatives) and is well
understood, valued, and supported by both employers and employees. A
policy development process that involves employees and gives them
ownership over health and workplace issues that affect them is most likely
to achieve this level of support and commitment.
Workplace policies that support tobacco-free living have two primary
objectives:3
1. To minimize exposure to second-hand smoke (SHS)
2. To promote tobacco cessation and support employees who are trying
to quit or reduce tobacco use
This section provides information on the benefits of creating a workplace
tobacco use policy and the process for doing so, including how to develop,
implement, maintain, and evaluate a policy. Sample policies are provided for
workplaces to use as a starting point.
Benefits of a Tobacco-Free Policy in the Workplace:3
Effective policies can result in benefits to both employees and employers.
Tobacco-free policies in the workplace can:
Protect employees from second-hand smoke exposure. In Canada,
23 per cent of non-smoking workers were exposed to second-hand
smoke at their workplace in 2011.4 In 2011, over half of Canadians
reported having been exposed to second-hand smoke at building
entrances within the last month.5 A study of 28 office building
entrances in Toronto in 2011 showed air pollution to be significantly
higher at entrances where smoking was permitted.6
Reduce overall tobacco use by preventing smoking initiation,
supporting quit attempts, and helping former smokers stay smoke-
free within a workplace environment that de-normalizes tobacco use7
Reduce smoking both inside and outside of work hours8-9
Make good business sense: each worker who smokes is estimated to
cost their company an additional $3,396 per year10
143 Project Health – Tobacco-Free Living: What Works at Work!
Portray a positive company image as employers make efforts to
promote a safe and healthy workplace
Increase employee morale, improve health, reduce absenteeism,
and increase worker satisfaction11
Reduce hospital admissions. The International Association for
Research on Cancer found extensive smoking bans in workplaces to
be followed by 10 per cent - 20 per cent reductions in hospital
admissions for acute coronary events in the first year post-ban7
Promote workplace compliance with Smoke-Free Ontario Act
legislation
Fulfil Canadian workers’ expectations and desire to work in a
workplace that is tobacc0-free. Over a third of Canadians think
smoking should not be allowed anywhere in the workplace, whether
indoors or outdoors, and most believe smoking should only be
allowed in designated smoking areas (DSAs, also known as ‘smoking
shelters’) outside the workplace12
Policy Development Steps There are three important steps to consider when creating and
implementing a workplace tobacco use policy:13
1. Plan
2. Implement
3. Evaluate and maintain
Plan for the Policy
The involvement of both
management and staff
at all stages of policy
development will help
build support for the
policy across the
organization and sustain
future compliance. To
the extent possible,
involve all stakeholders
right from the start.
144 Project Health – Tobacco-Free Living: What Works at Work!
A workplace wellness committee may be a suitable venue for health-related
policy development. Invite staff from all areas or departments to
participate. Ensure you have good representation from workers,
administrative staff, supervisors, managers, human resources personnel,
and others, so that all areas of the workforce can provide input into the
policy. Have members of the wellness committee work together to evaluate
whether developing a policy is appropriate for the workplace by gathering
background information, gaining support, developing goals, and seeking
support from key decision makers. The following steps can be used to
develop or modify a tobacco-free living policy.
1. Identify, Describe, and Analyze the Problem14
The clear identification, description, and analysis of a problem are starting
points in the journey towards policy development. Since all other actions
stem from the way the problem is identified, it is important to invest time in
this process. Use the following questions to guide problem analysis:
Is tobacco use a problem in the workplace? What are employees’
attitudes and beliefs about tobacco in the workplace? How big of a
problem is tobacco use, who does it effect, when did it become a
problem? (See the Getting Started section for tips on conducting an
employee survey/needs
assessment.)
What are the issues surrounding
tobacco use? Is second-hand
smoke a problem? Is lost
productivity an issue because
employees take extra breaks?
What factors in the workplace
support or discourage tobacco use
(e.g., scheduled breaks, shift work,
stress, outdoor smoking areas,
social climate around smoking,
etc.)?
What has been done to try to
resolve the problem to date?
145 Project Health – Tobacco-Free Living: What Works at Work!
What is the cost of the problem (human and financial)? Use information
in this toolkit regarding the health and business benefits of promoting
tobacco-free living. Outline the costs of doing nothing (see Smoking and
the Bottom Line in the Appendix) to calculate the cost savings a policy
could result in for your company.
Who would be positively or negatively affected by a tobacco policy?
When reviewing existing policies and procedures ask:
o Are there any existing policies on tobacco use?
o Are there current policies and procedures that encourage worker
tobacco use (e.g., unnecessary hazards in the workplace, longer
shifts than necessary, other stressful work conditions, etc.)? Can
these be modified to create a supportive environment?
2. Assess Workplace Support, Capacity, and Readiness14
Before deciding to implement a policy, assess:
The amount of support from staff to address tobacco use and proceed
with policy development
o Conduct a needs assessment (see the Getting Started section)
The level of capacity in the workplace to develop, implement, enforce,
and maintain a policy
o Are there staff members who will be responsible for developing,
implementing, and maintaining the policy?
o Are resources available to support policy accompaniments, such
as smoking cessation programming?
o Are there other policies or programs being implemented in the
workplace that might take time or focus away from this policy?
146 Project Health – Tobacco-Free Living: What Works at Work!
The level of workplace readiness to embrace a policy
o Are decision-makers in favour of such a policy?
o Gauge the readiness of an organization to change its status quo
regarding tobacco use. This will help to predict the degree of
support and opposition that will likely be encountered when
developing or modifying a tobacco policy.
o Is anything anticipated to happen in the future which might
affect the policy? How will new employees be informed of the
policy?
o Plan to review the policy annually and revise as needed.
When assessing workplace
support, capacity, and readiness,
assess workplace views about
tobacco use and the likelihood
that a policy will be supported. Try
to predict how a policy proposal
will be received by identifying
those who will likely support and oppose the policy. This can be particularly
useful for identifying and responding to potential counter-arguments
against a policy. After carefully examining the problem as well as workplace
capacity, support, and readiness, a decision can be made about whether or
not to proceed with developing a policy on tobacco use.
3. Develop Goals and Objectives14
Setting clear, measurable, and attainable goals and objectives is an
important part of the policy development process. A goal is a broad
statement that summarizes the ultimate direction or desired achievement of
a policy. For example, a workplace goal regarding tobacco use could be:
Reduce environmental tobacco smoke on company property.
Help employees who use tobacco to access and utilize proven cessation aids.
Reduce the total number of employees who use tobacco.
Foster and sustain a 100 per cent smoke-free environment.
147 Project Health – Tobacco-Free Living: What Works at Work!
Objectives are brief statements that specify the desired impact or effect of a
policy (i.e., how much of what should happen, by whom, by when).
Objectives specify direction towards the achievement of a policy goal.
Objectives should be SMART: Specific, Measurable, Actionable, Realistic,
and Time-oriented for them to be most useful. For example, objectives of a
tobacco policy in the workplaces could include:
Decrease the proportion of workers who smoke in the workplace by 10 per cent
within three years.
Offer 100 per cent health benefits coverage for prescription cessation
medications and nicotine replacement therapy to employees and their
dependents by the end of the year.
25 per cent more smokers at the workplace will use health benefits for smoking
cessation than currently do within the next year.
4. Build Support for the Policy14
Gaining the support of those who will be affected by the policy and the
decision-makers responsible for implementing a policy is critical; without
this support, a policy will not succeed.14 Decision makers are people with the
authority to endorse a policy. Identify individuals who have both official
decision making authority and those who influence decision makers.
Help decision-makers understand the need to proceed with the policy.
Focus communication messages on the links between the policy,
workplace tobacco use, and health. Use simple language and emphasize
that change is warranted and desired
Prepare to counter arguments such as: the policy will be too costly, it is
not the workplace’s responsibility to help employees reduce or quit
using tobacco, and that there are other ways to promote tobacco-free
living besides policies
Link the policy to a relevant compelling issue or problem
Build as many plausible links between the health issue and the desired
policy as you can
Clearly explain proposed solutions
Look for signs that indicate a need for change (e.g., dissatisfaction with
the status quo)
148 Project Health – Tobacco-Free Living: What Works at Work!
5. Write and Revise the Policy14
When developing a policy, the drafting or writing process is usually done by
a small subcommittee (two to
three people), with a designated
lead writer.
The committee assumes
responsibility for writing drafts
of the policy, obtaining
feedback from other
stakeholders (as appropriate)
and undertaking revisions to the
policy.
The following points should be taken into consideration when writing and
revising the policy:
Develop the policy. Look at a variety of policy options (some are
provided later in this section) and decide what you want to include in
your policy. For instance, do you want to create a complete tobacco ban
in your workplace? Or restrict tobacco use to outside nine metres of
buildings? Will employees be able to access supports during work time?
Include what you hope to achieve (objectives of the policy), define the
policy and what it includes, when the policy will be implemented, and
how it will be enforced. Example policies are provided later in this
section.
Present the policy to key management and employee
representatives for approval. Ensure management and supervisors
understand the importance of the policy from a business and health
perspective to encourage the promotion of it to employees. (See the
Background section for information on the business case of tobacco-free
living.) If necessary, revise the policy to create something that will be
meaningful, clear, followed, and enforceable.
Gather information about your organization before policy
implementation, such as anonymous group health data (tobacco use
rates, the presence of health conditions related to tobacco use, etc.)
from employee surveys, the benefits provider or employee assistance
program. This information can be used as baseline data when evaluating
policy effectiveness later on.
149 Project Health – Tobacco-Free Living: What Works at Work!
Ensure the following conditions are met before embarking on policy
implementation:
The policy meets stated goals and objectives and appropriately
addresses the issue/problem
There is sufficient information about the issue to support and justify the
implementation of the policy
The policy objectives are measurable and an evaluation plan is in place
Decision makers and stakeholders support and have approved the policy
An accurate estimate of the resources (time, money, person power, and
expertise) needed to implement and monitor the policy has been
developed
The timeline is realistic and appropriate
The policy specifies roles and responsibilities of staff and management
Possible barriers to implementation have been identified and a plan for
dealing with these barriers has been developed
Ensure that the policy implementation plan includes a communication
plan so that all individuals affected by the policy are aware of policy
specifics and expected behaviour before the policy is launched (i.e., at
team/department meetings, orientation sessions, etc.)
It has been determined that this is the right time to start policy
implementation
150 Project Health – Tobacco-Free Living: What Works at Work!
WRITING A TOBACCO-FREE POLICY
A policy typically includes an objective, definitions, and expectations of
employee behaviour. A policy should be equitable, sustainable (and not
forgotten about), and enforceable (where there are meaningful consequences
for unsafe, unhealthy, and/or prohibited behaviour). Policies should be made
available to all employees and managers and adherence to the policy should be
monitored.
Each workplace may have a standardized format for their policies. However,
there are some common sections across most templates. See Figure 1 for
examples for these common sections.
Policy Options
Smoking indoors is restricted under the Smoke-Free Ontario Act (SFOA), so
it is not necessary to repeat this in a workplace policy. However, a good first
step may be to remind workers about employer and employee
responsibilities under the SFOA, available in the Background section of this
toolkit.
Restrictions in addition to the SFOA are important components of a
tobacco-free policy. Restricting where workers can smoke outside can
reduce the visibility of tobacco use in the workplace, which shows
employees that smoking is not common or normal at the workplace;
encourages employees to make a quit attempt; protects all individuals on
workplace property from second-hand smoke; and supports people who are
trying to quit. Policies that restrict tobacco use may be particularly helpful
for industries with higher rates of tobacco use. There are typically three
options when implementing a tobacco-free policy on company property:15
1) Restrict tobacco use to a distance away from buildings, typically nine
metres
2) Restrict tobacco use to a designated smoking area (DSA), or
‘smoking shelter’ only
3) Completely restrict tobacco use on all company property by
implementing a complete tobacco ban
151 Project Health – Tobacco-Free Living: What Works at Work!
1) Distance away
from buildings
A recent study of
Canadian workplaces
found 45 per cent of
workplaces from various
industries restrict
smoking within a certain
distance of company
buildings.16 This can
reduce the likelihood of smoke entering a building through doors, windows,
and intake vents, and helps to reduce worker exposure to second-hand
smoke, for which there is no safe level of exposure.17 The SFOA requires
hospitals, long-term care facilities, and other workplaces that fall under the
Public Hospitals Act, Private Hospitals Act, the Mental Health Act, Nursing
Homes Act, the Charitable Institutions Act, Homes for the Aged and Rest
Homes Act, and the Independent Health Facilities Act to have a nine-metre
smoke-free radius at any entrance or exit.18 Research indicates that a
distance of at least six metres provides some protection from environmental
tobacco smoke.19 However, implementing a policy that stipulates a distance
of nine metres away from entrances and exits may be less confusing for
workers who experience the nine-metre requirement at the facilities
previously mentioned.
2) Designated Smoking Areas (DSAs), outdoor ‘smoking shelters’
Restricting smoking to Designated Smoking
Areas (DSAs) outdoors can further reduce the
visibility of smoking on company property,
especially if a DSA is built away from buildings
and public areas. Tobacco Enforcement
Officers can provide help to workplaces
considering creating a DSA on their property.
If your workplace decides to use a DSA,
remember that if it has a roof (which is
recommended), it can have no more than two
walls. It must be noted that providing places to
smoke on company property, including DSAs, has been identified as a
barrier to quitting smoking among workers. Providing places to smoke may
reinforce the social nature of smoking, which can make quitting more
difficult.20
152 Project Health – Tobacco-Free Living: What Works at Work!
3) Complete tobacco ban
Some workplaces choose to implement complete
smoke-free grounds policies, meaning smoking is not
allowed anywhere on company property. This
requires workers who smoke to move off of company
property to do so. Complete grounds bans have been
shown to produce beneficial effects both in terms of
helping smokers quit and reducing tension between
workers who smoke and those who do not.21-22
Complete tobacco bans may be particularly useful at
outdoor construction worksites where it is not always
clear when a construction site becomes an enclosed
workplace.23
However, complete grounds bans may not be appropriate for every
workplace. For instance, if there are no safe places for employees to relocate
off company property, this could create a safety issue for workers.
Companies with expansive grounds may encounter difficulties with the
length of time needed for smokers to move off of company property to
smoke, and non-smokers may perceive longer break times taken by smokers
as unfair. Forcing employees to move off company property may also result
in more smokers in public places, which could increase cigarette litter and
tobacco smoke in areas of high pedestrian traffic, neither of which are
beneficial for company image.
Other Options
Although the above three policy options are
the most common, other policies have been
developed and successfully implemented in
workplaces. Some workplaces have
implemented policies that put restrictions
on WHEN employees may use tobacco
instead of WHERE. This type of policy might
stipulate that employees are only allowed to
use tobacco before and after work and on
their lunch hour, thereby prohibiting any
smoking during work time (e.g., four hours
in the morning, four hours in the afternoon),
including during morning and afternoon
153 Project Health – Tobacco-Free Living: What Works at Work!
breaks. This type of policy can be more challenging for workplaces that have
employees working various shifts (e.g., 12 hr shifts). Another policy option
could involve allowing employees to utilize cessation supports like telephone
or online counseling or attend cessation programming during work time. Or,
if electronic cigarettes are identified as an issue in your workplace, see the
appendix for information on these products and policy options pertaining to
their use.
Unique workplace policies can be developed to address specific workplace
characteristics or issues identified. Policies that result from a carefully
conducted assessment and are customized to the workplace are most likely
to be successful and sustainable over time.
154 Project Health – Tobacco-Free Living: What Works at Work!
Figure 1: Common Policy Sections with Examples
Introductory Statement (A statement that introduces the concept of the policy.)
Example: (Employer name) recognizes the role of tobacco-free environments in the maintenance of health and wellbeing and will foster a workplace culture where not smoking is valued and encouraged.
Rationale/Objective/Purpose (Concrete examples about why your workplace is implementing the policy – i.e., what is the goal of the policy.)
Example: To ensure that employees are not exposed to environmental tobacco smoke (ETS) and the workplace promotes living smoke-free.
Scope (The definition of where your policy is applicable.)
Example: The policy applies to all workplace property, both indoors and outdoors.
Definition (The definition of what is considered “tobacco-free living”; so that people know what is included.)
Example: Tobacco-free living is living without tobacco products (cigarettes, cigars, hookah pipes, chew tobacco, etc.), at home, at work, and in social settings. This policy focuses specifically on tobacco-free living in the workplace.
Principles/Procedures/Requirements (How the policy will be accomplished. Select appropriate policies for your workplace that addresses your workplace needs assessment.)
Example: Anyone who smokes on company property will do so only in the Designated Smoking Area.
Example: Employees will have access to and be made aware of resources in the workplace and community to help smokers quit or reduce tobacco use.
Example: Employees will be encouraged to use cessation aids such as counseling, nicotine replacement therapy, and pharmaceuticals prescribed by a physician.
Responsibilities - Management:
Example: Management is responsible for being familiar with their responsibilities under the Policy.
Example: Ensuring that the Policy is posted in the workplace in a visible and accessible spot.
Example: Investigating and dealing with incidents of non-compliance with the Policy.
Responsibilities - Employees:
Example: Being familiar and following through with their responsibilities under the Policy.
Training and Information (How managers and employees will learn about the policy and where they can go for reference materials to assist in following the policy.)
Example: All employees will be provided with appropriate information and instruction on the contents of the Policy.
Monitoring and Accountability (How the organization will monitor compliance and what will happen if the policy is not followed?)
Example: Departments must periodically evaluate the implementation of this Policy and be able to demonstrate compliance.
155 Project Health – Tobacco-Free Living: What Works at Work!
Sample Policies3
156 Project Health – Tobacco-Free Living: What Works at Work!
Haliburton, Kawartha, Pine Ridge District Health Unit - Smoke-free
workplace policy resource kit
http://www.projecthealth.ca/sites/default/files/DOCS_ADMIN-%231183737-
v1-HKPR_SMOKE-FREE_WORKPLACE_KIT.PDF
Global Smokefree Partnership - Designing a 100% smokefree workplace
policy
http://www.globalsmokefreepartnership.org/ficheiro/18.pdf
Canadian Centre for Occupational Health and Safety - Environmental
Tobacco Smoke Policy
http://www.ccohs.ca/oshanswers/psychosocial/ets_resolutions.html
University of Guelph Health and Safety Policy - Smoking in the Workplace
https://www.uoguelph.ca/ehs/sites/uoguelph.ca.ehs/files/13-07.pdf
SAMPLE POLICIES
157 Project Health – Tobacco-Free Living: What Works at Work!
Healthier Worksite Initiative CDC (USA)
http://www.cdc.gov/nccdphp/dnpao/hwi/downloads/CDC_tobacco_policy.p
df
Government of South Australia - Smoke–free workplaces: A guide for
workplace in South Australia
http://www.tobaccolaws.sa.gov.au/Portals/0/WPA_2012Smoke-
freeWorkplaceGuide.pdf
Health Promotion Agency for Northern Ireland - Sample workplace smoking
policy
http://www.healthpromotionagency.org.uk/Resources/tobacco/pdfs/sample
%20workplace%20smoking%20policy.pdf
Other Considerations
Provide cessation supports (see Supportive Environment section)
If workplaces are going to implement a policy that impact’s employee’s
ability to use tobacco, they should ensure cessation support is offered to
employees and they have adequate time to utilize the support prior to the
policy launch date.3 Taking the time to do this will reduce tension in the
workplace, increase acceptance of a policy, and make a policy easier to
enforce.3 See the Supportive Environment section for what cessation
supports to offer and how.
Communicate the policy to ALL staff
Communicate details of the policy well in advance of its implementation to
allow employees the opportunity to ask questions and make adjustments in
their behavior in preparation for compliance with the new policy. People are
more likely to follow a policy if they see the benefit of it, so providing
reasons for the policy, such as how it will improve worker health and
conditions in the workplace, may help with compliance. Remind workers
about a new policy frequently and in a positive way – anticipate that workers
will forget about certain aspects of the policy in the beginning and provide
gentle reminders when this happens.
SAMPLE POLICIES
158 Project Health – Tobacco-Free Living: What Works at Work!
Implement the Policy14
Set a start date for the policy and provide enough time before this
date to promote the policy to staff. Managers and supervisors should
be aware of the policy so they may further promote it among staff.
Keep employees informed at each step of policy implementation.
Make sure tobacco-free boundaries are clearly marked.
Train staff involved in the implementation and enforcement of the
policy. Make sure responsibilities and procedures are clear.
Provide training for all employees during new employee orientation.
Make the policy accessible by distributing copies to all employees
and posting it in common areas. Ensure the policy has been explained
to all staff through information sessions, training sessions, or at staff
meetings. Allow employees to ask questions about the policy in
person, via email, telephone, or otherwise.
Hold an event to launch the policy and celebrate a healthier work
environment!
Enforce the Policy
Smoke-free policies tend to be self-enforcing with high compliance rates.24
Of Canadian workplaces surveyed by the Conference Board of Canada in
2013, 73 per cent of organizations reported monitoring compliance with
smoking bans, and only 23 per cent reported experiencing issues with non-
compliance.16 While self-enforcement reduces the need for enforcement
duties, it is still important to have clear processes and procedures in place in
case compliance issues arise. The most prevalent issues related to policy
non-compliance reported by Canadian organizations include:16
Improper disposal of cigarette butts
Second-hand smoke from smoking areas near building entrances
Smokers who do not respect restrictions related to smoking a set
distance away from buildings
Smokers who take breaks, especially when these are outside of
employer-sanctioned breaks
Air quality and smell in company vehicles after a smoker has used it
Restricting clients or customers from smoking in non-designated
areas
159 Project Health – Tobacco-Free Living: What Works at Work!
When drafting a policy, develop a procedure for enforcement. Identify who
will be responsible for enforcement and receiving complaints (usually
management) and how this will be done – i.e., ask for complaints to be
provided in writing, either via e-mail or in hard-copy. Having complaints
written can be useful to track how the policy is going and issues employees
have with it, in case modifications need to be made in the future. It is helpful
to have a statement of how infractions will be dealt with in the policy itself.
For example, “violation of this tobacco use policy will result in discipline, up to
and including discharge under COMPANY XY’s progressive discipline policy.”25
It is recommended to have a progressive discipline process, giving verbal
warnings first, followed by written warnings, and then job-related action
(e.g., suspension, dismissal).25 Ensure you do not make employees enforce
the policy or act as peace-makers.25
Employers are responsible for ensuring
employees abide by both the Smoke-Free
Ontario Act as well as additional voluntarily
implemented tobacco-free workplace
policies. Durham Region Health Unit has
developed a user-friendly guide, Smoke-
Free Workplace Enforcement Protocol
(www.durham.ca/departments/health/idt/sf
WorkplaceProtocol.pdf), which includes
example enforcement protocols that may
be included in tobacco-free policies.
Evaluate and Maintain the Policy14
Evaluation is important to assess program effectiveness and identify ways to
improve in the future.
A thorough evaluation will help to:
Collect evidence on the effectiveness of a policy (i.e., was it
successful in achieving its stated goals and objectives)
Be accountable to stakeholders who supported the development and
implementation of the policy
Identify ways to improve the policy by determining what works, what
doesn’t work and why
Determine the usefulness of the resources and materials needed to
implement the policy and assess the extent of compliance with the
policy
160 Project Health – Tobacco-Free Living: What Works at Work!
There are two types of evaluations a workplace can use to assess a policy:
process and outcome evaluations.
Process evaluation monitors the implementation of the policy. This looks at
the procedures and tasks involved in carrying out the policy in an effort to
determine ‘what is happening to whom.’ Process evaluation may include:
Tracking the number of policy infractions
Tracking the quantity and type of activities carried out to implement
a policy (e.g., number of communication methods used to inform
employees of the policy, number of launch events, number of
training sessions provided to employees on the policy)
Assessing the quality of the activities carried out to implement a
policy (e.g., employee satisfaction with how the policy was
communicated, launched, introduced)
Documenting resources and supports provided to employees (e.g.,
cessation supports for those trying to quit, conflict resolution
training)
Tracking modifications to your policy over time
Outcome evaluation assesses the results or impacts of a policy, both
intended and unintended and short-term and long-term impact to
determine whether or not the policy made a difference. Short-term impact
measures can include evaluating things such as policy awareness, employee
morale, situations of conflict and conflict resolution, work quality, and job
satisfaction. Long-term impact can be evaluated by looking at rates of
tobacco use in the workplace, absenteeism, health care, and maintenance
costs. Outcome evaluation may include:
Tracking how many employees are aware of and follow the policy
Assessing employee perceptions of the policy over time (e.g. support
for the policy or not)
Identifying changes in employee awareness and skills regarding
tobacco-free living
Identifying changes made to the work environment to support
tobacco-free living
Tracking how many employees participate in tobacco-free living
programming
161 Project Health – Tobacco-Free Living: What Works at Work!
Be sure to document Process and Outcome evaluations to keep track of
trends over time. Here are some important points to consider when
designing policy evaluation:
Base evaluation measures on the goals and objectives of the policy –
objectives should be measurable, so measure them!
Select realistic methods to collect evaluation data such as
questionnaires, surveys, and focus groups
Make sure data is collected systematically from the moment a policy
is implemented. Do not wait until a policy has been in place for a long
period of time before starting to evaluate its impact
Review the evaluation results on a regular basis to guide appropriate
changes and modifications to the policy
Include a mix of quantitative (numerical) and qualitative
(descriptive/opinion-based) data in the evaluation process. Both
types of information are needed to fully understand the impact of a
policy
Use evaluation results to inform changes to the policy. Effective healthy
workplace policies are not static; they are flexible enough to incorporate
insights gained from past experience while responding to future
developments and trends. After the policy has been implemented, it is
important to reflect by looking back and thinking about the future.
Looking Back
Is the situation better than it was before the policy was
implemented?
If the policy was not as effective as anticipated, why not? What could
have been done differently?
Are people who were involved in the policy development and
implementation process happy with the results of their efforts?
Do the people affected by the policy have a favourable view of the
policy? If not, what can be done to address their concern
Looking Ahead
Does more need to be done to implement the policy?
Does the policy itself need to be revised?
Are there any foreseeable developments that may affect the policy?
162 Project Health – Tobacco-Free Living: What Works at Work!
A Tobacco Use Policy Should…
Hint: Use this when evaluating your policy!
Make tobacco use less ‘normal’ and create a culture for
tobacco-free living at work
When tobacco use is less visible, it becomes less of a socially
acceptable activity
Tobacco-free policies can reduce the likelihood that non-smokers will
start to smoke because coworkers smoke26
Tobacco-free policies reduce worker exposure to environmental
tobacco smoke, which protects workers and helps those trying to
quit
Encourage and recognize participation in tobacco-free living
wellness programs
Incentives can be used to increase participation (e.g., certificates, t-
shirts, lunch bags, paid time off work)
Develop a policy allowing workers to access tobacco cessation
services and programs (on-site, EAP provider, website, telephone,
etc.) during work hours
Tobacco-free living programming can be integrated into mandatory
occupational health and safety workshops and events to include all
employees
Support tobacco-free living efforts more broadly
Ensure comprehensive benefits coverage is provided for proven
tobacco cessation aids
Promote tobacco-free living at company events, even when off
company property
Include spouses and family members in benefits coverage and
incentive programs or competitions – social support at home can
make quitting more likely27,28
163 Project Health – Tobacco-Free Living: What Works at Work!
Give instruction on providing and maintaining environmental
supports
Develop and maintain an outdoor Designated Smoking Area, or
‘smoking shelter’ if your workplace has decided to offer this for
smokers
Provide adequate signage so all employees are aware of both the
SFOA and additional tobacco use policies
Ensure people comply with smoking a certain distance away from
buildings or off company property if a smoke-free grounds ban is
implemented and refrain from littering
Direct who will provide tobacco-free living strategies and
programs, and how frequently this will occur
Identify qualifications required for cessation counselors (your EAP
provider might have qualified instructors)
Ensure group programming is led by a counselor or nurse (e.g.,
through EAP provider)
Managers and supervisors may be responsible for an incentive
program or quit competition
Provide programming regularly throughout the year to support
workers making quit attempts. It can take many attempts to achieve
success, and it is important to support quit attempts whenever they
are made
164 Project Health – Tobacco-Free Living: What Works at Work!
Frequently Asked Questions
Are guidelines the same as policies?
No, guidelines are not the same as policies. Guidelines exist to provide
employees with information they may use to make healthier lifestyle
choices, for example, guidelines on how to reduce tobacco use. There is no
explicit expectation that individual employees will follow guidelines or
experience consequence if they do not follow guidelines.
A policy is different than a guideline in that the behaviour outlined in a policy
is expected and/or required of employees, and it is not left to the employees’
discretion as to whether or not they will follow the policy.
Is a commitment statement the same as a policy?
No, a commitment statement is different than a policy. A commitment
statement shows that your workplace cares about employee health. For
example, “our organization is committed to reducing exposure to
environmental tobacco smoke in the workplace and helping our employees
to reduce tobacco use.” Although a commitment statement shows a positive
intent, it is difficult for employees to decipher how this statement should
affect their behaviour. For example, how is environmental tobacco smoke
going to be reduced, and what are employees expected to do as a result of
this statement?
As a result of a formalized policy, employees who smoke know that they are
only allowed to do so in certain areas, if at all while at work. Employees who
do not smoke should expect to not encounter environmental tobacco smoke
while at work. A policy defines: what tobacco-free is, when and where
tobacco use is permitted, links to resources to help employees who smoke to
access cessation supports, and lists the consequences of not following the
policy.
Is having a policy the same as creating a supportive
environment?
No, having a policy is not necessarily the same as creating a supportive
environment, although both can work towards achieving the same goal.
Supportive environments create an environment that fosters good health.
Within a supportive environment, employees feel that the organization
provides them with encouragement, opportunities, and rewards for
developing or maintaining a healthy lifestyle. While policies can help to
165 Project Health – Tobacco-Free Living: What Works at Work!
create a supportive environment, sometimes supportive environments are
created in the absence of policy.
Example: Supportive environment in the absence of a workplace policy
A workplace decides to move benches and other places where people might
gather outside while using tobacco a certain distance away from entrances
and exits, to create a ‘smoking shelter.’ However, without a policy that
specifies that workers who use tobacco must do so only in either the shelter
or at least a certain distance away from entrances and exits, workers may
move benches closer to the building or disregard the shelter, especially on
nice days. Without a written tobacco use policy, the health benefits of
restricting tobacco use to certain areas may not be understood by
employees and therefore employees who use tobacco may continue to do so
where it is convenient for them, and where others are exposed to
environmental tobacco smoke.
166 Project Health – Tobacco-Free Living: What Works at Work!
References
1 NSW Department of Commerce Office of Industrial Relations. Workplace policies and procedures
[Internet]. Darlinghurst, (NSW): NSW Department of Commerce Office of Industrial Relations; 2011 [cited 2013 June 28]. Available from: http://www.industrialrelations.nsw.gov.au/ 2 Health at work. A guide to writing and implementing a physical activity policy in the workplace
[Internet]. date unknown [cited 2012 Feb 16]. Available from: http://www.healthatwork.org.uk/pdf.pl?file=haw/files/PhysicalActivityPolicy.pdf. 3 Program Training and Consultation Centre. How to make your workplace tobacco-free: A toolkit for
the development of a tobacco control policy at the workplace [Internet]. Ontario: Program Training and Consultation Centre; [cited May 22 2013]. Available from: https://www.ptcc-cfc.on.ca/common/pages/UserFile.aspx?fileId=104468 4 Stonebridge C, Bounajm, F. Smoking cessation and the workplace: Briefing 1 – Profile of tobacco
smokers in Canada [Internet]. Ottawa (ON): The Conference Board of Canada; 2013 April [cited 2013 June 7]. Available from: http://www.conferenceboard.ca/e-library/abstract.aspx?did=5422) 5 Health Canada. Canadian Tobacco Use Monitoring Survey. Canada: Health Canada; 2011. Available
from: http://www.hc-sc.gc.ca/hc-ps/tobac-tabac/research-recherche/stat/ctums-esutc_2011-eng.php 6 Kaufman P, Zhang B, Bondy SJ, Klepeis N, Ferrence R. Not just ‘a few wisps’: real-time measurement
of tobacco smoke at entrances to office buildings. Tob Control. 2011 May;20(3):212-218. 7 Smoke-Free Ontario – Scientific Advisory Committee. Evidence to guide action: Comprehensive
tobacco control in Ontario [Internet]. Toronto (ON): Ontario Agency for Health Protection and Promotion; 2010 [cited June 28]. Available from: http://www.publichealthontario.ca/en/eRepository/Evidence%20to%20Guide%20Action%20-%20CTC%20in%20Ontario%20SFO-SAC%202010E.PDF 8 Ontario Tobacco Research Unit. Workplace restrictions on smoking: Are they good for the smoker,
too? [Internet]. Ontario: 2004 [cited 2012 Sept 17]. Available from: http://otru.org/wp-content/uploads/2012/06/update_oct2004.pdf 9 Moher M, Hey K, Lancaster T. Workplace interventions for smoking cessation. Cochrane Database of
Systematic Reviews. 2005 [cited 2013 June 28];(4);CD003440. 10
Hallamore C. Smoking and the bottom line: Updating the costs of smoking in the workplace. Ottawa, ON: Conference Board of Canada. 2006: 1-11. 11
Canadian Centre for Occupational Health and Safety. Environmental Tobacco Smoke (ETS): Workplace Policy [Internet]. [place unknown]: Canadian Centre for Occupational Health and Safety; 2011 [cited 2013 May 22]. Available from: http://www.ccohs.ca/oshanswers/psychosocial/ets_resolutions.html 12
Health Canada. Canadian Tobacco Use Monitoring Survey (CTUMS) [Internet]. [place unknown]: Health Canada; 2012 Sept 17 [cited 2013 Jul 15]. Available from: www.hc-sc.gc.ca/hc-ps/tobac-tabac/research-recherche/stat/index_e.html 13
York Region. Good Business... better health. A comprehensive guide for smoke-free workplaces [Internet]. [place unknown]; date unknown [cited 2013 Jul 10]. Available from: http://www.york.ca/NR/rdonlyres/v4habqqam2oph5zjx7kffjf3cxj6zptdsnswmuydqz3bltijhx2by6jn6hgwf7lertmaezu4yi3qbbsxuvm2ghb4cf/YORK-%23624459-v1-Good_business_better_health_Workplace_guide_1.pdf 14
The Health Communication Unit. Developing health promotion policies [Internet]. Toronto, (ON): University of Toronto; 2004 Mar [cited 2013 Jul 2]. Available from: http://www.thcu.ca/resource_db/pubs/539372877.pdf 15
Health Canada. Towards a healthier workplace: A guidebook on tobacco control policies. [place unknown]: Health Canada; 2007 [cited 2013 May 28]. Available from: http://www.hc-sc.gc.ca/hc-ps/pubs/tobac-tabac/work-trav/index-eng.php 16
Lamontagne E, Stonebridge C. Smoking cessation and the workplace: Briefing 2 – Smoking cessation programs in Canadian workplaces [Internet]. Ottawa, (ON): The Conference Board of Canada; 2013 June [cited 2013 June 28]. Available from: http://www.conferenceboard.ca/e-library/abstract.aspx?did=5565 17
Centres for Disease Control and Prevention (US). Surgeon General's Report – The health consequences of involuntary exposure to tobacco smoke. Atlanta (GA): US Department of Health and
167 Project Health – Tobacco-Free Living: What Works at Work!
Human Services; 2006 Apr [cited 2013 Jul 2]. Available from: http://www.cdc.gov/tobacco/data_statistics/sgr/2006/ 18
Durham Region Health Department. Promoting tobacco-free policies: A guide for workplaces. Durham Region (ON); Durham Region Health Department; 2011 [cited 2013 May 22]. Available from: http://www.durham.ca/departments/health/idt/promotingtobaccoFreePolicies.pdf 19
Fronzi L, Haughey K. Creating a supportive environment: smoke-free policy & cessation support [PowerPoint slides]. Brant County Health Unit; 2007. 20
Central East Tobacco Control Area Network. Literature review: Workplace cessation project. Ontario; 2012 Feb 24. 21
Voci S, Bondy S, Zawertailo L, Walker L, George TP, Selby P. Impact of a smoke-free policy in a large psychiatric hospital on staff attitudes and patient behavior. General Hospital Psychiatry. 2010;32:623–630. 22
El-Guebaly N, Cathcart J, Currie S, Brown D, Gloster S. Public health and therapeutic aspects of smoking bans in mental health and addiction settings. Psychiatr Serv. 2002;53:1617–1622. 23
Bondy S J, Bercovitz K L. Non-smoking worksites in the residential construction sector: Using an online forum to study perspectives and practices. Tobacco Control. 2011;20(3);189-195. 24
Global Smokefree Partnership [Internet]. [place unknown]: Designing a 100% smokefree workplace policy. Global Smokefree Partnership; date unknown [cited 2013 May 28]. Available from: http://www.globalsmokefreepartnership.org/ficheiro/18.pdf 25
Health Canada. Workplace Smoking: Trends, Issues and Strategies [Internet]. [place unknown]: Health Canada; 2010 [cited 2012 Aug 31]. Available from: http://www.hc-sc.gc.ca/hc-ps/pubs/tobac-tabac/1996-work-travail/index-eng.php 26
Pirrie M, McGrath H, Garcia JM, Lambraki I, Pieters K. Literature review: Workplace tobacco cessation initiatives for young adults. Waterloo (ON): Propel Centre for Population Health Impact, University of Waterloo; 2012. 27
Park E, Tudiver F, Campbell T. Enhancing partner support to improve smoking cessation. Cochrane Database of Systematic Reviews. 2012;7;CD002928. 28
Okechukwu CA, Nguyen K, Hickman NJ. Partner smoking characteristics: Associations with smoking and quitting among blue-collar apprentices. American Journal of Industrial Medicine. 2010;53(11);1102-1108.
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168 Project Health – Tobacco-Free Living: What Works at Work!
APPENDIX
Ap
pe
nd
ix
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Smoking and the bottom line: Updating the costs of smoking in
the workplace
The Conference Board of Canada updated its 1997 study on the cost of smoking to a business
or organization and found that the total costs have increased from $2,565 per smoking
employee in 1997 to $3,396 in 2006. The cost of smoker absenteeism has increased from $230
to $323, and the cost of decreased productivity due to smoke breaks has gone from $2,175 to
$3,053. However, smoking facilities costs have decreased, from $85 in 1997 to $20 in 2006,
likely as a result of increased bans on smoking at the workplace.
Table 1: The Annual Costs of Employing Smokers
Cost Factor
Cost in 1997
Cost in 2006
Increased absenteeism 230 323
Decreased productivity 2,175 3,053
Increased life insurance costs 75 0
Smoking facilities costs 85 20
Employee Absenteeism
Table 2: Calculating Additional Absenteeism Cost
COST Absent = DAYS LOST Smoker x DAILY WAGE x (1 + BENEFITS and TAXES) = 323
COST Absent
Annual per-employee cost due to increased absenteeism (in dollars per employee)
DAYS Lost
Number of additional days in absenteeism taken by a smoking employee compared with a non-smoker
DAILY WAGE
Average daily wage (weekly wage of $717.50, divided by five working days)
BENEFITS and TAXES
Payroll taxes and benefits paid by employer (supplementary labour income) expressed as a percentage of payroll
172 Project Health – Tobacco-Free Living: What Works at Work!
Employee Productivity
Table 3: Calculating Cost of Lost Productivity
COST Prod = CIGS x TIME (minutes) x WAGEAverage x (1 + BENEFITS and TAXES) x DAYS WORKED = $3,053
COST Prod
Annual loss of productivity (in dollars per employee)
CIGS
Average number of cigarettes smoked per day at work during non-sanctioned break periods (assumption: two)
TIME
Time taken to travel to smoking area and consume cigarette (assumption: 20 minutes per break)
MINUTES
Number of minutes in an hour (60)
WAGE Average
Average hourly wage (weekly wage of $717.50, divided by 40 hours)
BENEFITS and TAXES
Payroll taxes and benefits paid by employer (supplementary labour income) expressed as a percentage of payroll
DAYS WORKED
Number of days worked per year
173 Project Health – Tobacco-Free Living: What Works at Work!
Cleaning Time
Table 4: Calculating Facilities Costs
Formula 1 (Ashtrays)
ASHTRAY + ($ASHTRAY/ASHDURA) / SMOKE-EMP = $8.50
ASHTRAY Overall cost of ashtrays to employer (dollars per employee)
$ASHTRAY Median annual cost of three ashtrays (assumption $212.50)
ASHDURA Lifespan of an ashtray (assumption: three years)
SMOKE-EMP Number of employees served by one ashtray (assumption:25)
Formula 2 (Cleaning Time)
ASHCLEAN =
(CLEANTIME/MINUTES) x WAGECLEAN x (1 + BENEFITS and TAXES) x (WORKYEAR) = $11.34
SMOKE-EMP
ASHCLEAN Cost of cleaning ashtrays in the workplace (dollars per
employee)
CLEANTIME
Average amount of time taken to clean ashtrays
(assumption: 20 minutes)
MINUTES
Number of minutes in an hour (60)
WAGECLEAN
Average hourly earnings for “administration and support, waste
management and remediation services”
($581.30 divided by 40 hours)
WORKYEAR
Number of weeks in a year (52)
BENEFITS and TAXES
Payroll taxes and benefits paid by employer (supplementary
labour income) expressed as a percentage of payroll
SMOKE-EMP
Number of employees served by one ashtray (assumption: 25)
Total smoking facilities
costs
ASHTRAY + ASHCLEAN = $20
Adapted from: Health Canada, Smoking Cessation in the Workplace: A guide to helping your employees quit smoking, 2007.
174 Project Health – Tobacco-Free Living: What Works at Work!
Health Benefits of Quitting Smoking
Health Benefits Time From Last
Cigarette
Blood pressure drops to normal 20 minutes
Pulse rate drops to normal 20 minutes
Blood carbon monoxide level drops to normal 8 to 12 hours
Nicotine by-products removed from body 2 days
Sense of taste and smell is sharpened 2 days
Bronchial tubes start to relax, easier breathing 3 days
Lung capacity begins to improve 3 days
Walking, aerobic exercise becomes easier 3 days
Circulation improves, experiences more energy 2 weeks to 3 months
Bronchial cilla begin to re-grow and clean lungs 1 month
Coughing, sinus congestion, shortness of breath decrease 1 to 3 months
Risk reduced by 50% of developing Coronary Heart Disease 1 year
Reduced risk of mouth, esophageal, throat, and bladder cancer 5 years
Risk of dying from lung cancer is cut in half 10 years
Risk of dying from a heart attack is the same as a person who has never smoked
10-15 years
Adapted from: Brief Counselling for Tobacco Use Cessation: A Guide for health professionals, 2012.
175 Project Health – Tobacco-Free Living: What Works at Work!
Dealing with Nicotine Withdrawal
Here are some of the most common withdrawal symptoms and some ideas for coping with
them:
Withdrawal symptom Suggestions for coping
Tension, irritability Go for a walk; take deep breaths; keep busy with activities
Depression Use positive self-talk; speak to a friend or family member; speak with your health care provider if depression is intense or does not improve
Headaches Drink water; deep breathing; take a mild pain reliever
Dizziness Sit or lie down until it passes; change positions more slowly
Trouble sleeping Take a hot bath or do relaxation exercises before bed; avoid caffeine; do not nap during the day
Difficulty concentrating Avoid additional stress; take a brisk walk; break bigger projects into smaller tasks and take regular breaks
Cough, dry throat Drink plenty of water; use soothing lozenges; chew gum
Hunger Eat balanced regular meals; eat healthy, low-fat snacks such as fresh fruit and vegetables; drink plenty of water
Constipation Drink plenty of water; eat high-fibre foods such as fruits, vegetables, and whole grains; get regular exercise
Adapted from: Health Canada, Smoking Cessation in the Workplace: A guide to helping your employees quit smoking, 2007.
176 Project Health – Tobacco-Free Living: What Works at Work!
Dealing with Tobacco Cravings
There are times, places, and situations that will trigger the urge to use tobacco, even after you
have stopped feeling withdrawal symptoms. It is important to be aware of what triggers your
cravings and have some strategies for coping with them.
Some common triggers include:
Coffee or alcohol
Other people smoking
First thing in the morning
After school or work
Talking on the phone
Driving in the car
After eating
Parties or social gatherings
Stress
Anger
Feeling lonely or sad
Boredom
Use the Tobacco Use Tracking Sheet to help identify your triggers and then use the following
chart to help you plan coping strategies for each trigger.
Trigger Coping Strategy
Coping Strategies - Try using the 4 D’s:
Drink Water – six to eight glasses a day
Delay – for five to seven minutes, the urge should pass
Distract – do something else, be active, start a new hobby to keep your hands busy
Deep breath – can help you relax and focus your mind on something else
Adapted from: Health Canada, Smoking Cessation in the Workplace: A guide to helping your employees quit smoking, 2007.
177 Project Health – Tobacco-Free Living: What Works at Work!
Understanding Your Habit
Use this chart to record your smoking habit. The more you know about your behaviour, the better your chances of quitting
Cigarette
number Time of Day
Intensity Rating
(1=low, could have done
without; 5=I really had to
have this cigarette)
What was I doing? Where was I? Who was I with? Reasons for smoking
(Eg.) 1 7:15 5 Drinking coffee Kitchen Kids Pick me up
Source: Nicotine Dependence Clinic, CAMH, 2011. In: Selby P, Herie M, Dragonetti R, Chapchuk R, Lecce J, Baarker M, fahim M, Parchment S, Sliekers S, Czyzewski K, Timothy V. A
comprehensive course on smoking cessation: Essential skills and strategies. [place unknown]: TEACH PROJECT, Centre for Addiction and Mental Health; 2011.
178 Project Health – Tobacco-Free Living: What Works at Work!
Reasons for Change
Making a commitment to meeting your goal is important to your success. Sometimes, it’s easy
to forget why you’re making the change, so write down your reasons and use this as a reminder
to yourself when things seem tough!
The most important reasons that I want to change are:
1.______________________________________________________________________________
_______________________________________________________________________________
___________________________________________________________________________
2.______________________________________________________________________________
_______________________________________________________________________________
___________________________________________________________________________
3.______________________________________________________________________________
_______________________________________________________________________________
___________________________________________________________________________
Source: Nicotine Dependence Clinic, CAMH, 2011. In: Selby P, Herie M, Dragonetti R, Chapchuk R, Lecce J, Baarker M, fahim
M, Parchment S, Sliekers S, Czyzewski K, Timothy V. A comprehensive course on smoking cessation: Essential skills and
strategies. [place unknown]: TEACH PROJECT, Centre for Addiction and Mental Health; 2011.
179 Project Health – Tobacco-Free Living: What Works at Work!
Decisional Balance Sheet
Try to fill out your personal reasons for why you continue to use tobacco and why you may
want to quit.
Continue smoking Quit smoking
Benefits of:
Costs of:
Source: Nicotine Dependence Clinic, CAMH, 2011. In: Selby P, Herie M, Dragonetti R, Chapchuk R, Lecce J, Baarker M, fahim M,
Parchment S, Sliekers S, Czyzewski K, Timothy V. A comprehensive course on smoking cessation: Essential skills and strategies.
[place unknown]: TEACH PROJECT, Centre for Addiction and Mental Health; 2011.
180 Project Health – Tobacco-Free Living: What Works at Work!
Readiness Ruler
Now that you have thought about some of your reasons for change, where would you rate the
importance of actually making these changes? How confident do you feel about whether you
can make this change? How ready are you to start the journey of change?
How important is it to change this behaviour?
0 1 2 3 4 5 6 7 8 9 10
How confident are you that you could change this behaviour?
0 1 2 3 4 5 6 7 8 9 10
How ready are you to make this change?
0 1 2 3 4 5 6 7 8 9 10
List 2 things you can do to move to the next number on each scale.
Importance of changing behaviour:
1. ____________________________________________________________________________
2. ____________________________________________________________________________
Confidence in ability to change behaviour:
1. ____________________________________________________________________________
2. ____________________________________________________________________________
Readiness to change behaviour:
1. ____________________________________________________________________________
2. ____________________________________________________________________________
Source: Nicotine Dependence Clinic, CAMH, 2011. In: Selby P, Herie M, Dragonetti R, Chapchuk R, Lecce J, Baarker M, fahim M, Parchment S, Sliekers S, Czyzewski K, Timothy V. A comprehensive course on smoking cessation: Essential skills and strategies. [place unknown]: TEACH PROJECT, Centre for Addiction and Mental Health; 2011.
181 Project Health – Tobacco-Free Living: What Works at Work!
Quit Day Plan
The date I plan to stop smoking is: _______________________________________________
My top three reasons for quitting smoking are:
1. ________________________________________________________________________
2. ________________________________________________________________________
3. ________________________________________________________________________
The people I will ask to support me are:
______________________________________________________________________________
The rewards I plan to give myself for stopping tobacco use after:
One day ________________________________________
One week ________________________________________
One month ________________________________________
This is how I will deal with:
Withdrawal
______________________________________________________________________________
Cravings
______________________________________________________________________________
This is what I will carry around to help me replace tobacco:
______________________________________________________________________________
_________________________________
Signature
_________________________________
Witness Signature
Source: McLean K, d’Avernas J, Lynch D, Appah F, Steibelt E. Brief counseling for tobacco use cessation: A guide for health professionals. [place unknown]: Program Training and Consultation Centre;2008.
182 Project Health – Tobacco-Free Living: What Works at Work!
Smoking Cessation in the Workplace: Comparing the Different
Approaches
Approach Pro Con
Comprehensive Offering programs and activities at the workplace
More accessible
More flexible (e.g., can be offered at various times to accommodate shift and other workers)
Sends a strong message of commitment and support from employer
Demonstrates employer’s leadership
May provide additional motivation
Can be offered to spouses and family members
Easy to target hard-to-reach groups
Supports ex-smokers
Can provide follow-up and support
Can integrate cessation supports into existing workplace wellness initiatives
Can build on existing tobacco control policies
High costs, in terms of financial and human resources
Group programs may not suit all employees
Extensive training may be required
Does not allow for anonymity
May not accommodate different levels of addiction and readiness to quit
There may be more and broader expertise and resources in the community
Focusing on smokers in the workplace may stigmatize them and decrease success rates
Facilitated Working with outside agencies to deliver programs and activities off-site, and providing self-help materials
Offers anonymity
Makes use of external expertise, which means not “re-inventing the wheel” and ensures a level of expertise that may not exist within a workplace
Employees can select the options that work best for them
Some communities have a variety of options to choose from and many resources (especially larger centres)
Sends a message of commitment and support from employer
Less accessible
May be high cost in terms of human resources at the outset
Less flexible
Less easy to tailor to specific workplaces
There may be fees
Finding acceptable options may be difficult
Education and information Providing employees with information including self-help materials
Low cost
Better than no support at all if this is all that can be done
All workplaces can take this approach
Offers anonymity
Good option for highly motivated smokers
The quit rates are lower for self-help
Education and information is not enough to change behavior
Lacks ongoing support
Shows a lower level of support from employer
Employees may not feel they are able to quit successfully on their own and this can be a barrier to action
Follow-up is not possible Adapted from: Health Canada, Smoking Cessation in the Workplace: A guide to helping your employees quit smoking, 2007.
183 Project Health – Tobacco-Free Living: What Works at Work!
Electronic Cigarettes
An electronic cigarette, or e-cigarette, is a device made of stainless steel or plastic that mimics a
cigarette in terms of its appearance and use.1 A typical electronic cigarette consists of three parts: a
cartridge containing liquid; an atomizer containing a heating element which turns the liquid into a
vapour; and a battery to power the atomizer and the indicator light that glows when the user
inhales.1 The cartridges can be refillable or pre-filled disposable and may or may not contain
nicotine.1
In Canada, only one of three types of e-cigarettes can be sold legally:1,2
E-cigarettes without nicotine, that do not make a health claim, can be sold in Canada
provided that they meet the general safety requirements of the Canada Consumer Product
Safety Act.
E-cigarettes that contain nicotine cannot be sold in Canada as they have not yet received
market authorization under Food and Drug Act.
E-cigarettes that are marketed with a health claim cannot be sold in Canada as they currently
do not comply with the Medical Devices Regulations.
Health Canada prohibits the importation, sale, or advertising of e-cigarettes in Canada that either
contain nicotine or make a health claim.2 In 2009, Health Canada issued a public advisory “not to
purchase or use electronic smoking products,” as they may pose health risks and “have not been fully
evaluated for safety, quality, and efficacy.”2 In August 2012, the Ontario Ministry of Health and Long
Term Care informed Public Health Units that the Smoke-Free Ontario Act (SFOA) does not cover e-
cigarettes since the products do not contain tobacco.
There is a concern that the use of e-cigarettes in public places and workplaces will undermine
tobacco control efforts and the SFOA, which make smoking less visible and normal; reduce cues for
smokers who have recently quit or are trying to quit; and prevent youth from initiating smoking.3
Workplaces can chose to implement a policy of their own which would address the use of e-
cigarettes. Policy options could include:
Banning the use of e-cigarettes indoors just like the SFOA prohibits smoking in an enclosed
workplace
Or if a workplace already has a smoke-free grounds policy, they could ban the use of e-
cigarettes anywhere on company property
Workplaces that implement policies which go beyond the SFOA legislation are responsible for
deciding how the policy will be enforced and by whom.
1 Non Smokers’ Rights Association. The Buzz on E-Cigarettes. Booklet. 2012 2 Health Canada. Health Canada Advises Canadians to not use electronic cigarettes. Advisory 2009-53, March 27. Online. Retrieved February 27, 2013 from http://www.hc-sc.gc.ca/ahc-asc/media/advisories-avis/_2009/2009_53-eng.php. 3 Smoke-Free Ontario –Scientific Advisory Committee. (2010). Evidence to guide action: Comprehensive Tobacco Control in Ontario. Toronto, ON: Ontario Agency for Health Protection and Promotion.
