Exploring Employers' Understanding and Perceptions of the Business Impact of Smoking
National Business Group on Health
October 2007
In October 2007, the National Business Group on Health conducted an employer online survey about smoking. This survey was part of an educational initiative sponsored by Pfizer Inc. The survey polled 506 benefits decision-influencers from companies (with 1,000 or more employees) that offer health benefits. 253 employers were from companies with 1,000-9,999 employees (smaller-sized companies) and 253 employers were from companies with 10,000+ employees (large-sized companies). The survey explored:
- Employers' level of knowledge and concern regarding smoking and its associated health risks.
- Employers' understanding and perceptions of the business impact of smoking.
- Types of cessation programs and resources employers provide.
- Barriers to implementing comprehensive smoking cessation benefits as outlined by the Centers for Disease Control and Prevention (CDC).
The Centers for Disease Control and Prevention (CDC) and the Agency for Healthcare Research and Quality (AHRQ) recommend that a company include all of the following components in its smoking cessation benefits:
- Cover at least four counseling sessions of at least 30 minutes each, including telephone and individual counseling sessions.
- Cover smoking cessation prescription medications.
- Cover over-the-counter nicotine replacement medication.
- 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.
Survey Results
Employers Knowledge and Beliefs about Smoking
Employers consider smoking to be one of the most important employee health issues.
- Smoking was ranked the second most important employee health issue to employers (51%); obesity ranked first (54%).
The majority of employers recognize that smoking is more than just a habit; however, there are still many who consider smoking a "lifestyle choice."
- 79% of employers classify cigarette smoking as an addiction.
- 52% of employers believe that cigarette smoking is a lifestyle choice.
- 13% of employers classify smoking as a relapsing medical condition. Employers from large-sized companies are more likely than those from smaller-sized companies to classify smoking as a relapsing medical condition (18% vs. 8%).
The Importance of Workplace Support
Employers understand the importance and necessity of offering smoking cessation benefits.
- 83% of employers from smaller-sized companies and 87% of employers from larger-sized companies would like to reduce the smoking prevalence within their workforce.
- 70% of employers rank offering smoking cessation benefits as the most valuable way to encourage employees to quit or reduce smoking.
Employers view offering smoking cessation benefits as a way to both improve the health of their employees and decrease health care costs.
- "Improving the health of employees" (78%) and "decreasing health care costs" (74%) are the top-ranked ways that employers see smoking cessation benefits helping their company.
- 85% of employers from smaller-sized and larger-sized companies believe that providing smoking cessation benefits to help employees quit or reduce smoking can be cost-effective for their company.
Employers consider the following to be the most harmful costs associated with smoking:
- 66% Long-term medical costs
- 61% Direct medical costs
- For 60% of employers, employee productivity is also a factor, but is less of a concern than health care costs.
What Employers Cover
Overall, employers provide various components of the comprehensive smoking cessation benefits recommended by the Centers for Disease Control and Prevention (CDC).
- Employers most frequently cover:
- 62% Counseling sessions
- 61% Prescription medications
- 27% of employers make efforts to minimize or eliminate co-pays or deductibles for counseling and medications.
Although most employers believe the CDC-recommended guidelines for employer-sponsored smoking cessation benefits are beneficial and effective, employers are most likely to offer only two out of the five recommended components.
- 71% of employers believe that it is beneficial to provide employees with all of the components of smoking cessation benefits as outlined by the CDC.
- 93% of employers believe that the CDC guidelines would be effective in helping employees to quit smoking if implemented.
- 74% of employers believe that their company would be likely to provide their employees with all of the components of smoking cessation benefits as outlined in the CDC and Agency for Healthcare Research and Quality (AHRQ) recommended guidelines.
- Despite employers' high regard for the CDC guidelines, only 2% of companies provide comprehensive smoking cessation benefits for employees. 19% offer none of these components.
At the same time, employers report that smoking cessation efforts have increased over the past year.
- 52% of employers report that their company is doing more this year than it did in the previous year in terms of encouraging employees to quit smoking.
- Large companies were more likely than small companies to report that their company has done more to encourage employees to quit smoking this year than the previous year (56% vs. 47%).
- Most common additions that companies have made to their company smoking cessation efforts:
- 42% Establishing a smoke-free workplace policy
- 35% Covering counseling
- 32% Covering prescription medications
83% of employers report that their company is going to implement at least one new policy to reduce smoking; however, few anticipated that they would cover multiple quit attempts for employees.
- Anticipated additions to smoking cessation programs:
- 41% Requiring smokers to pay higher health insurance premiums.
- 27% Establishing a smoke-free workplace policy.
- 27% Offering financial incentives to quit smoking.
- Employers least frequently cited covering multiple quit attempts in the next couple of years (16%).
Motivating Employers to Cover Smoking Cessation Benefits
While most employers are covering at least one component of the CDC-recommended smoking cessation benefits, two out of ten companies are not implementing any component.
- Employers' most frequently cited barriers to offering smoking cessation benefits are:
- 34% None of their employees has asked for it.
- 34% The company hasn't considered it.
Reducing health care costs is the top ranked outcome (82%) that employers report would motivate their company to provide employees with smoking cessation benefits.
- In addition, 57% of employers report that "increased on-the-job productivity" would motivate their company to offer smoking cessation benefits and 46% report that "a reduction in absenteeism" would motivate their company.
State or city smoke-free air policies can have an impact on the types of smoking cessation benefits that companies offer.
- 46% of employers whose state or city has a smoke-free air policy report that the policy influenced their decision to offer or broaden the types of smoking cessation benefits they offer.
- Employers whose state or city has a smoke-free air policy in place are more likely to cover prescription medications to help employees reduce or quit smoking than employers whose state or city does not have a smoke-free air policy in place (64% vs. 51%).
- 42% of employers whose state or city does not have a smoke-free policy in place believe that it would influence their company's decision to offer smoking cessation benefits if their state or city implemented such a policy.
The Perceived Financial Impact of Smokers
Despite the motivating appeal of reducing health care costs, there is still uncertainty about how much smokers actually cost their employers.
- 43% of employers report that they don't know how much the average adult smoker costs their employer in excess medical expenditures annually.
- The median amount that employers believe that smokers cost their companies a year in excess medical expenditures annually is $2,000.
- Employers from large companies believe that smokers cost 33% more than employers from small companies.
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