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Windsor-Essex (W.E.) Can Quit: Helping Employees Quit Through the Workplace

Contents

I Introduction: Tobacco use in Ontario – Everyone’s business
II Tobacco use in Windsor-Essex County
III Windsor-Essex (W.E.) Can Quit: Workplace Smoking Cessation Pilot
IV Workplace Partnerships
V Program Implementation
VI Evaluation  
VII W.E. Can Quit Impact and Findings
VIII Implications
IX Next Steps

--Submitted by Shawna Scale, H.P. Specialist, Windsor-Essex County Health Unit

I Introduction: Tobacco use in Ontario – Everyone’s Business

The consequences of tobacco use are well known. Not only does tobacco kill over 13,000 Ontarians prematurely each year [1] and contribute to an ever-growing list of chronic conditions [2], but its use substantially impacts Ontario’s workforce and economy. Each smoker in the workplace costs their employer $3,396 per year in decreased productivity, increased absenteeism, increased insurance premiums and additional expenses to maintain outdoor smoking areas. [3] Consequently, tobacco use contributes to $1.93 billion in direct health care spending and $5.8 billion in productivity losses each year. It is no surprise that smoking cessation initiatives offered through the workplace have shown to provide a significant return on investment to the employer in terms of health, social, and economic gains. [4]  

II Tobacco use in Windsor-Essex County

Tobacco use and tobacco-related harm are of significant concern in Windsor-Essex County.  Despite a relatively low current smoking rate of 19% [5] overall, about one-third of men and one-fifth of women, aged 20 – 65 years are smokers. [6] Windsor-Essex County has the highest unemployment rate in Canada. The local economy is heavily reliant on the manufacturing sector, which employs about 24% [7] of the local workforce. With significantly higher smoking rates found among low-income persons and persons employed within the manufacturing sector, the need to address tobacco use is not only important for public health, but good for business, too.  

III Windsor-Essex (W.E.) Can Quit: Workplace Smoking Cessation Pilot

W.E Can Quit is a unique workplace smoking cessation pilot, focused on tailoring smoking cessation options within different types of workplaces. Developed by the Windsor Essex County Health Unit (WECHU), the pilot was conceived as means to reduce the number of smoking-related illnesses and deaths of employees, retirees, and their dependents by enhancing the quality, type and relevancy of cessation supports available through the workplace. The program was funded by Health Canada’s Federal Tobacco Control Strategy with the goals of determining which combination of smoking cessation components work best with different sectors, and of developing a workplace smoking cessation model, using existing resources, that is adaptable to other communities across Ontario and Canada.  

W.E. Can Quit Logo

The W.E. Can Quit Model

W.E. Can Quit is an evidence-based program model, informed by a comprehensive review of smoking cessation research, grey literature, existing cessation models and anecdotal workplace feedback gained through WECHU’s Working Towards Wellness program. Provincial, national and international sources were consulted. The model supports a “no wrong door” [8] approach by engaging workplaces and pharmacies in the provision and promotion of cessation supports.

IV Workplace Partnerships

Partnerships with local workplaces are utilized to reach and support employees, retirees and family dependants who are ready to quit. Seven workplaces were identified and approached to represent key labour sectors – manufacturing, mining, service, education, government, media and healthcare. Due to timing, a media representative was unsecured. One workplace per sector was selected, based on its capacity to carry out the program, willingness to enhance current workplace cessation offerings and ability to commit time and a workplace contact towards the project. Workplace partnerships were formalized through a signed Memorandum of Understanding.  

W.E. Can Quit Program Components

W.E. Can Quit is offered through the workplace and within the community at participating pharmacies. Depending on interest and need, multiple program components can be accessed:

Self-Help Materials: accessible by request from key workplace contacts or through wellness kiosks, available within each workplace.

Workplace Activities: employed by the workplace to engage employees in cessation activities and encourage program uptake (e.g., quit contests, cessation support groups, workplace health screenings and newsletter features).  

Community Activities: offered externally, but communicated and promoted at the workplace for employee use (e.g., local cessation groups, WECHU’s Tobacco Hotline and the Driven to Quit Challenge).

http://www.wecanquit.ca, an on-line resource, coordinates cessation-related information, highlights workplace-specific activities and is available for employees, retirees and family members to discretely access from home or work.

W.E. Can Quit Pharmacy Component offers employees, retirees and family dependants access to a trained pharmacist, up to 12 week supply of free quit smoking aids (NRT, Champix and Zyban), referral to Smokers Helpline (SHL) through its Fax Referral program, and up to six bi-weekly follow-up counseling sessions. The pharmacy component is delivered by brief-intervention trained pharmacists at seven participating Shoppers Drug Mart locations situated throughout Windsor and Essex County.  

V Program Implementation

To inform W.E. Can Quit, needs assessments were undertaken at each workplace between January and May, 2010.  Organizational needs assessments were carried out to understand workplace cessation offerings, policies, employee benefits coverage, and known smoking-related concerns.  Employee needs assessments were used to identify employee smoking behaviour (prevalence, consumption rates, nicotine dependence, past quit attempts, stages of change), confirm desired workplace cessation supports and develop messaging and workplace promotions.  

The W.E. Can Quit program formally launched on October 1st, 2010 and was available to participating workplace employees, retirees and their family dependants for six months, ending March 31st, 2011.  

VI Evaluation  

An evaluation of the program was undertaken in March, 2011. Surveys, key informant interviews and focus groups were used to engage a cross section stakeholders, including workplace wellness contacts, pharmacists involved with the pharmacy component, former-smoker W.E. Can Quit participants, and non-participant current smokers from partnering workplaces. The evaluation report, along with a presentation, can be downloaded at www.wecanquit.ca.  

Following is a summary of the results:

  •  
  • The W.E. Can Quit brand recognition and visibility within the workplace was high among all employees. Across workplaces, recognition and visibility ranged from 73% to 100%.  Overall, current smokers reported the highest rates recognition and visibility (88%).    
  • Awareness of the full range of W.E. Can Quit offerings was found to be moderate among employees and across workplaces, ranging from 50% to 79%.  Just over half (56%) of all employees reported being fully aware of the pharmacy component, website, self-help materials, community and workplace events. Not surprising, recent quitters and current smokers were more likely to be aware of the program, as compared to never smokers and former smokers.
  • Within six months of implementation, W.E. Can Quit reached 681 (23%) of the estimated 2657 individuals making up the pooled workplace smoking population.  Reach was calculated by distribution of program booklets, tracked as received by 681 employees. On average, each booklet was reported to have been passed on to 2.6 people, with reach likely higher.
  • 233 (34%) of individuals reached utilized W.E. Can Quit’s pharmacy component. Participants were slightly more likely to be female (59%); employees (74%) vs family members (26%); have a mean cigarette intake of 20 per day (range 5 – 40);  smoked for 21 years or more (69%); and an average age of 43 years.  The use of NRT (52%) and quit medications (48%) was equally distributed. A survey conducted with current smokers and recent quitters who participated within W.E. Can Quit focus groups found similar results.
  • 109 (47%) or almost half of all W.E. Can Quit’s pharmacy component participants had made at least one quit attempt in the past year (range 0 – 8 attempts). Attempts were slightly lower than reported among W.E. Can Quit focus group participants (61%; range 0 – 20).  On average, smokers and recent quitters had made five attempts to quit during their lifetime, ranging from 0 – 30 attempts across both groups.
  • 155 (67%) of pharmacy component participants were referred to Smokers’ Helpline (SHL), and 55% engaged in counseling or other services. During its six months of implementation, W.E. Can Quit was responsible for 10% of all provincial referrals through the SHL’s Fax Referral Program.
  • 98 (42%) of participants failed to return for their Day 14 follow up. However, at least 64 (28%) participants attended their Day 42 follow up. Due to compressed program timelines and the continuous intake process of the program, quit rates at six months were not available at the time of reporting.

VII W.E. Can Quit Impact and Findings

Workplaces were pleased with the outcome of the program, reporting impacts at the employee level as well as the organizational level. As a result of their participation within W.E. Can Quit, workplaces reported increased awareness of the issue of tobacco use and its economic implications, better capacity to address the issue within the workplace and a greater commitment to improve cessation offerings through policy and programming.  Consequently, four out of six workplaces are in the process of creating or revising organizational tobacco control policies. In addition, three out of six workplaces are reviewing their employee benefits coverage to try and cover quit medications or remove lifetime maximums. To date, one workplace has successfully removed the financial and lifetime cap on its coverage of cessation medication.   

Pharmacists were very supportive of the program and found its structure and comprehensive approach led to greater impacts with clients, as compared to similar programs. When surveyed, they rated the program easy to administer (3.83 of 4), program materials useful to initiate conversations with their clients (3.83 of 4), and useful to support referrals (3.83 of 4). Top outcomes of the program were enhanced client relationships, greater confidence to address and integrate cessation within their practice, and improved business results through store traffic and additional purchases.

Regardless of smoking status, 83% of employees reported being very satisfied with the program, in particular the efforts of their employers to assist employees who smoke to quit.  Smokers and recent quitters at one workplace reported positive coworker support created a ‘snowball effect’, where one person quitting encouraged several peers to quit.  For employees using the pharmacy component, free coverage, as well as the two-week pharmacy follow-up sessions was found to be most motivating and useful.

VIII Implications

Based on its preliminary results and findings, W.E. Can Quit is a model for other public health units to consider to engage workplaces [9, 10] in addressing tobacco use and expand cessation-related offerings within their communities. It recognizes the need to engage workplaces in health promotion through policy and the responsibility of employers to promote healthier lifestyles through enhanced support and implementation of innovative programs. Finally, the W.E. Can Quit model is a good fit with Chronic Disease Prevention sections 4.0 and 9.0 of the Ontario Health Promotion Standards (2008).  

IX Next Steps

Planning for Phase 2 of W.E. Can Quit is underway with a proposal submitted to Health Canada in late spring, 2011.  At present WECHU is awaiting final notification of approval. W.E. Can Quit, Phase 2 will focus on examining the results and feedback gained from the evaluation and re-implementing an enhanced program in partnership with all six original workplaces.  A ‘How To’ toolkit is planned for development in Phase 2, to support similar program development or adaptation of the W.E. Can Quit model within other public health units or workplaces.  

References

1. Ontario Tobacco Research Unit. (2010). A Model for Assessing Gaps in Smoking Cessation Systems and Services in a Local Public Health Unit.
2. Health Canada (2007). On the Road to Quitting.
3. Conference Board of Canada (2006) Smoking and the Bottom Line: Updating the Costs of Smoking in the Workplace.  
4. Janneke van’t Klooster. (2009)  Smoking Cessation in the Workplace, What Works
5. Statistics Canada (2011) Health Profile, CCHS, 2009 cycle
6. Statistics Canada (2011) Health Profile based on CCHS, 2009 cycle
7. Service Canada. (2009) Labour Market Survey.
8. Tobacco Strategy Advisory Group.  Building On Our Gains:  2011-2016.  
9. TD Economics (May 2010). Charting a Path to Sustainable Health Care in Canada.
10. Smoke Free Ontario Scientific Advisory Committee. (2010).  Evidence to Guide Action: Comprehensive Tobacco Control in Ontario.