Smoke Free Environments and Tobacco Cessation
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Transcript of Smoke Free Environments and Tobacco Cessation
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Smoke-Free Environments and Tobacco CessationThe Boston Experience
Margaret Reid, RNDirector, Healthy Homes & Community Supports
Boston Public Health Commission 11/13/2012
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Reasons to invest in tobacco policies and benefits
Influence of tobacco-free policies Importance of tobacco cessation benefits
Case study in Boston Questions
Overview
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Why invest in tobacco prevention?
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Smoking Impacts Productivity
Nonsmokers
Former Smokers
Current Smokers
Mean days missed for work d/t health conditions/year
4.4 days 4.9 days 6.7 days
Mean hours lost d/t absenteeism/year
35.2hours 39.2hours
53.6hours
Mean hours lost d/t presenteeism/year
42.8 hours 56.0 hours
76.5 hours
Journal of Occupational and Environmental Health, Volume 48, Number 10, October 2006.
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Implement policies that discourage tobacco use◦ Increase taxes on tobacco and packaging◦ Create smoke-free public places
Provide support for smokers who want to quit◦ Offer high-quality cessation benefits
Prevent youth tobacco use◦ Disrupt tobacco marketing to youth
Strategies to reduce tobacco use
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2003:Smoke Free
Workplace Law
Passed
2008: Smoke Free
Workplace Law
Updated
August 2011:Smoke Free Tot
Lots Designate
d
April 2012: Smoke Free
Hospital Campuses
September 2012: Smoke Free Boston
Public Schools Policy in Effect
October 2012: Smoke Free
Public Housing Policy in Effect
Creating Smoke-Free Places in Boston
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Smoke free policies are effective because◦ They make smoking inconvenient;◦ They change the norm around what is
acceptable behavior;◦ They convey the importance of protecting
others from secondhand smoke. SF policies result in less secondhand
smoke exposure and increase the likelihood that smokers quit.
Smoke Free Policies Are Effective
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Policy change alone is not sufficient to achieve the goal of reducing tobacco use.
A robust, barrier-free cessation benefit is a proven way to help people quit◦ Education and outreach to
promote benefit is important
Importance of Cessation Support
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Cessation benefits work best when they:◦ Cover the cost of counseling, including telephone,
individual and/or group counseling◦ Offer counseling sessions over a period of several
weeks and have high or no limit on sessions◦ Cover all FDA-approved cessation aids, including
prescription and over-the-counter drugs◦ Limit out-of-pocket expenses for those making a
quit-attempt◦ Do not require preauthorization
Barrier Free Cessation Benefits
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Prescription Medications
Nicotine Replacement Therapy (OTC)
Zyban (bupropion hydrochloride)
Nicorette (Gum)
Chantix (varenicline) Nicoderm CQ, Nicotrol (Patch)
Nicotrol NS (Spray)
Nicotrol Inhaler (Inhaler)
Cessation Aids
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Case Study: Cessation Benefits in for Boston Employees
Insurance Plan Cessation Counseling Benefit Cessation Pharmacy Benefit
Gold Standard Offers bi-lingual telephone counselingWill reimburse for 16 counseling sessions every 12 months, PA for counseling beyond this limit
Covers NRT and prescription medications;$1-3 co-pay
Major Insurer #1 Promotes Smokers Help Line and online support.Offers reduced rate for QuitSmart program
No coverage for NRT;$10 co-pay for generic drugs, $25 co-pay Chantix and Wellbutrin
Major Insurer #2 Promotes Smokers Help Line and online support.
Covers NRT and prescription medications;$10 co-pay for generics ; $25 for Chantix and Wellbutrin
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The City of Boston has about 18,000 employees, including the schools, public health, fire, police and other municipal departments
Employee benefits are negotiated between the Public Employee Committee and city management
The city is self-insured Boston currently contracts with Neighborhood
Health Plan, Blue Cross/Blue Shield, Harvard Pilgrim, and BMC HealthNet to offer insurance.
Case Study
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Men64%
Women35%
Unidentified1%
City of Boston Workforce: Gender
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Under 20 yrs0% 20-29 yrs
10%
30-39 yrs19%
40-49 yrs26%
50-59 yrs27%
60-69 yrs
12%
70+ yrs6%
City of Boston Workforce: Age
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White57%
Black21%
Hispanic8%
Asian3%
Amer-ican
Indian0%
Not Indicated10%
City of Boston Workforce: Race/Ethnicity
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Adult Current Smoking, 2010
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The City was in a contract negotiation year.
Management understood the ROI on offering a cessation benefit.
Outside forces – municipal health reform, interest in cost containment – contributed to readiness on both sides to negotiate.
Case Study: Setting the Table
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Public Employee Committee and Management agreed to look at a 4-year health benefit design, with a focus on reducing costs
Reducing costs = improving preventive care and increasing wellness benefits and chronic disease management
Improved cessation aligned with these goals.
Case Study: Negotiations
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Once PEC and Management agreed on cessation benefit, negotiations began with Insurer
For Insurer, big hurdle was whether they would have to file with the Division of Insurance to offer the change in benefit
Since Boston was self-insured, the insurer did not have to file, so the change was easier to make.
Case Study: Negotiations
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Major Insurer #1 Before AfterCessation Counseling Benefit
Reduced rate for QuitSmart program.
Added on-site cessation groups.Continues to promote Smokers Help Line and online support and reduced rate for QuitSmart program
Cessation Pharmacy Benefit
No coverage for NRT;$10 co-pay for generic drugs, $25 co-pay Chantix and Wellbutrin
Added coverage for NRT, most at Tier 1 co-pay level of $10.Continues coverage for prescription medications
Case Study: New Benefit
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Outreach: Outreach to employees so they are aware of the new benefit and know how to utilize◦ Postcards to homes, city intranet sites◦ Department Human Resource Directors educated◦ Letter from Mayor Menino to every employee◦ Promotion for Great American Smoke Out
Case Study: Next Steps
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Evaluation: Will be asking the insurer for data to assess uptake of the benefit by employees. ◦ Monitor adoption among other large Boston
employers◦ Continue to monitor smoking rates among
residents of Boston
Case Study: Next Steps
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Questions?