Survey of Employers Reveals Their Barriers to Supporting Tobacco-Control Programs
Partnership for Prevention, a Washington-based nonprofit organization that supports activities to prevent disease and promote health, surveyed 2,180 private- and public-sector employers and conducted four focus groups to explore workplace tobacco-cessation policies and practices.
Among the survey and focus group findings:
- Employer support for tobacco control and prevention programs remains low. Less than 25 percent of employers covered tobacco-cessation services in their health plans, and even fewer provided services at their worksites.
- Employers identified these barriers, among others, to implementing tobacco control programs: high cost, absence of return-on-investment information, interference with work time and concern about intruding into employee's lives.
- In order to expand tobacco-cessation programs, employers say they need models of successful programs, return-on-investment data, marketing and communications kits, educational materials for employees, and programs provided by health plans and pharmaceutical companies.
The Robert Wood Johnson Foundation (RWJF) supported this project with an unsolicited grant award of $102,572 from March 2002 to May 2004.
Partnership for Prevention, a Washington-based nonprofit organization, builds evidence to support sound disease prevention and health promotion strategies, and works in the public and private sectors to get appropriate policies and practices adopted.
Employers, the primary source of health insurance to workers, have an economic stake in discouraging tobacco use and many opportunities to do so (for example, by restricting workplace smoking and offering tobacco-cessation programs). Nonetheless, many fail to address the harm connected with tobacco use.
For example, the federal Department of Health and Human Services reports in Healthy People 2010 that 21 percent of employers with 50 or more employees did not prohibit smoking or restrict it to separately ventilated areas.
Under two earlier Robert Wood Johnson Foundation (RWJF) grants, the Partnership for Prevention examined the extent to which private insurance covers effective disease prevention services:
- Assessing Insurance Coverage of Preventive Services by Private Employers (see Grant Results on ID# 029975) surveyed health benefits managers. According to the 1997 survey:
- Only 22 percent of employer-sponsored health plans offer cessation benefits.
- Only 12 percent of those plans cover both counseling and pharmaceutical devices or drugs to help smokers quit.
- Examining Insurance Coverage for Clinical Preventive Services in Employer-Sponsored Health Plans (grant ID# 039745) extended the previous effort. Launched in January 2001, grant activities included collecting additional data; identifying practical strategies to improve coverage of preventive services; and disseminating results and recommendations.
RWJF has pursued a comprehensive strategy on tobacco cessation, providing more than $242 million in funds to improve tobacco control and promote the wider delivery and use of evidence-based cessation services. The strategy has involved:
- Push-proving, improving and communicating treatments for wide population use.
- Developing and disseminating standards for defining what is effective.
- Research to develop more effective interventions.
- Communications and advocacy geared to key decision-makers and end users.
- Building the capacity of health care and other systems to deliver effective treatments. This includes:
- Provider knowledge and practice.
- Provider training and tools.
- Health care systems' supports.
- New delivery systems such as quitlines.
- Integrated multichannel/multimodality systems.
- Pull-creating consumer and market demand for tobacco cessation and effective treatments, including:
- Population and market strategies that increase quitting and treatment use.
- Health Plans-efforts to expand tobacco-cessation treatment coverage and use among health plans and their enrollees.
- Employer-based programs.
- Synergistic approaches that combine several of these approaches together.
- Redesigning treatments and delivery systems to increase consumer appeal, engagement and use.
To identify gaps in employers' efforts to decrease tobacco use and strategies to convince them of the value of adopting tobacco-related policies and programs, the Partnership for Prevention:
- Surveyed 2,180 employers, contracting with Mercer Human Resources Consulting to add tobacco-related questions to Mercer's 2002 National Survey of Employer-Sponsored Health Plans. Mercer has been conducting this survey, which samples all public and private employers with at least 10 employees, since 1986. Questions covered:
- Tobacco-cessation services covered by health insurance.
- Tobacco-cessation services provided at the worksite.
- Worksite regulations on tobacco use.
- Conducted four focus groups, through a contract with Sally John Design, a marketing communications firm in Raleigh, N.C. Participants were employers and benefits managers from both small and large companies in geographically diverse areas. Among the issues discussed:
- Employer roles in employee tobacco use.
- Barriers to expanding support for tobacco control and prevention.
- Strategies for expanding support.
Partnership staff made oral presentations in 2002 and 2003 on the results of the survey and focus groups at seven conferences and meetings, including those held by the National Conference on Tobacco OR Health, Smoke Free Families and the Interagency Committee on Smoking and Health, a part of the U.S. Department of Health and Human Services.
Late in the project, the National Conference of State Legislatures provided information the partnership staff had sought about state statutes relating to insurance coverage for tobacco cessation and public and workplace smoking policies. Some of those findings were incorporated into the presentations.
Partnership staff combined results from this survey, and one completed a year earlier, in an article published in American Journal of Health Promotion (see the Bibliography).
Partnership staff reported these survey and focus groups findings:
- Employer support for tobacco control and prevention remains low. The survey found that:
- Less than a quarter of employers covered tobacco-cessation services in their health plans, and even fewer provided those services at their worksites.
- While almost 80 percent of employers did not permit smoking indoors at worksites, just under 60 percent allowed smoking outdoors on company facilities.
- In focus groups, employers identified both benefits and barriers to implementing tobacco control programs. Among the barriers:
- High cost.
- Lack of access to return-on-investment information.
- Interference with work time.
- Concerns about intruding into employee's lives.
- Feelings among non-smokers that spending money only on smokers is unfair.
- In focus groups, employers indicated that they are most likely to expand their role in tobacco control and prevention by:
- Offering a variety of programs.
- Making programs available without forcing employees to participate.
- Making all work events "smoke free."
- Providing telephone counseling.
- Using Employee Assistance Program services.
- In order to expand programs, employers say they need:
- Models of successful programs.
- Return-on-investment data.
- Marketing and communications kits.
- Educational materials for employees.
- Programs provided by health plans and pharmaceutical companies.
- Consider steps to get data into the hands of researchers, advocates and policy-makers rapidly. Given the time-consuming nature of peer review, it may be helpful to involve advisors and partners who can more quickly communicate new findings to colleagues. (Project Director)
AFTER THE GRANT
Partnership staff continues to disseminate findings by providing talking points and background notes to speakers at relevant conferences.
With funding from the Centers for Disease Control and Prevention (CDC) ($1 million), and the federal Agency for Healthcare Research and Quality ($100,000), Partnership staff began in 2003 to rank the benefits and cost-effectiveness of providing clinical preventive services, including tobacco cessation.
The Robert Wood Johnson Foundation provided $184,605 for the second phase of this study (see ID# 056019), which examines the health and economic impact of disparities-including socioeconomic status, age, race and ethnicity-on the use of preventive services.
RWJF is also supporting projects promoting expansion of comprehensive employer-covered tobacco-cessation services and policies through grants to:
- The Smoking Cessation Leadership Center (e.g. Oregon's Make It Your Business Campaign).
- The Consumer Demand Roundtable (see also Grant Results on ID# 055732).
- The Partnership for Prevention's National Commission on Prevention Priorities (ID#s 050161 and 053962).
GRANT DETAILS & CONTACT INFORMATION
Encouraging Employer Support for Tobacco Control and Prevention Policies
Partnership for Prevention (Washington, DC)
Dates: March 2002 to May 2004
John M. Clymer
(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)
Bondi MA, Harris JR, Atkins D, French ME and Umland B. "Employer Coverage of Clinical Preventive Services in the United States." American Journal of Health Promotion, 20(3): 214222, 2006. Abstract available online.
Report prepared by: Robert Stewart
Reviewed by: Karyn Feiden
Reviewed by: Molly McKaughan
Program Officer: C. Tracy Orleans