IAFF Smoking Cessation Fact Sheet (Redraft 5/11 and 6/2 08)

IAFF Smoking Cessation Facts

A Program to Help You Quit Smoking and Help Others Quit

• The IAFF - Pfizer smoking cessation collaboration, "Campaign for a Smoke-Free Union,” is a critical part of our health and safety work.

• At the 2008 IAFF Redmond Symposium, IAFF General President Harold Schaitberger announced his intent to make the IAFF the first smoke-free union. President Schaitberger and Pfizer CEO Jeff Kindler announced a partnership to work to achieve this goal.

• This campaign is a continuation and intensification of previous IAFF efforts. It combines the expertise of Pfizer, the world's largest pharmaceutical company, with the IAFF leadership commitment. And, for the first time, it sets a clear goal to make IAFF smoke-free. Finally, it focuses on developing institutional support for achieving this goal and brings to bear new technology and research-based knowledge to help smokers quit.

• Go to the new website () for a comprehensive resource. The site gives you information and assistance on how to quit smoking or to help a friend or loved one quit. This information should also assist Local Union representatives who negotiate for health care coverage. We want your feedback and your stories as we continue to build this resource.

• Smoking is the number one preventable cause of death.[1]

• Smoking poses risks to fire fighters: fire fighters are exposed to a broad range of risks, including heat and flames, extreme physical and psychological stress, and high levels of carbon monoxide and other toxic risks.[2] Fire fighters have a high risk for many diseases, and fire fighters who smoke are at even greater risk. Smoking contributes to the high risk for heart disease,[3]lung cancer,[4] chronic respiratory diseases,[5] stress,[6] and poorer treatment outcomes for hepatitis.[7]

• Smoking is a leading cause of fires which injure and kill our members.[8] A smoke-free society is therefore part of IAFF's fire prevention objectives. Beyond internal education and support, we can help educate our fellow public servants, authorities, and health care providers about the importance of a good smoking cessation benefit.

• Fire fightersencounter a high level of job-related stress[9] that can contribute to smoking and make it hard to quit.[10] Increased smoking is reported after particularly stressful events.[11] Our health plan coverage should be responsive to this reality of the job.

• All health insurance plans shouldprovide smoking coverage. This is especially important for fire fighters since they face many job-related risks that are increased if a fire fighter alsosmokes. IAFF Local Union representatives should work with their employersand other public employee unions in their jurisdictions to select health insurance plans that include coverage for smoking cessation.

• If your health plan does not cover smoking cessation, talk with your Local Union about what you can do to reach out to your health plan provider or the municipal office responsible for selecting health careproviders for your public sector union members. You can discuss the importance of a good smoking cessation benefit and how your Local Union can work with other unions in the area that negotiate along with IAFF with municipal authorities for health care coverage.

• The U.S. Public Health Service (PHS) strongly recommends that health care insurance should cover a broad range of treatment options to help smokers quit, including both behavior counseling and medications. Using a combination of behavioral counseling and medications increases the likelihood of quitting.[12] Exempting smoking cessation treatment from deductibles and co-pays, and allowing smokers as many quit attempts as possible, also greatly increases the likelihood of quitting.[13]Smoking cessation is very cost effective. The more smokers who quit, the more money the health insurance plans save.[14]

• The PHS Guidelines state that even brief interventions are effective and that all clinicians should offer treatment to smokers.[15]Surveys find, though, that doctors are much less likely to talk to "blue collar" patients about smoking cessation than other patients.[16] That is one reason why our initiative starts with our members.For more information on all the recommended treatments in the Guidelines, go to

• IAFF believes a model insurance benefit should include: screening for smoking, counseling, medications, an appropriate duration of treatment, benefits that target specific populations (e.g. pregnant women), and affordable out-of-pocket costs that do not act as a barrier to treatment as defined in the PHS Guidelines.[17]

Additional Information about the Costs of Smoking and Economic Benefits of Smoking Cessation

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Here are a few examples of the costs of smoking and the benefits to employers of providing smoking cessation coverage:

• Current smokers missed more days of work and experienced more unproductive time at work compared with former smokers and nonsmokers. The average annual cost for lost productivity for nonsmokers was $2,623 per year compared with $3,246 per year for former smokers and $4,430 per year for current smokers. More than half the costs were due to unproductive time at work.[18]

• According to Leif Associates,estimated savings would be approximately $1.3 million per year per 10,000 smokers if a health plan had no smokers.[19]

• An update to a 1992 study by T.A. Hodgson[20] estimates that average lifetime health costs (in 2004 dollars) for male smokers are $15,800 more than male non-smokers and for female smokers $17,500 more than for female non-smokers.[21]

• A 2007 study showed that employers recoup the costs of providing smoking cessation benefits in four years.[22]

• The annual return on investment and life-time return on investment for smoking cessation benefits have been estimated at 27% per year and up to 15 times cost over a smoker’s lifetime, respectively.[23]

References

[1]Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence:

2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008, p. 11 based on Centers for Disease Control and Prevention. Annual smoking-attributable mortality, years of potential life lost, and productivity losses—United States, 1997-2001. MMWR 2005;54:625-8.

[2]Rosenstock L, Olsen, J. Firefighting and Death from Cardiovascular Causes. New Eng J Med 2007; 356:1261-1263

[3] Kales SN, Soteriades ES, ChristophiCA, ChristianiDC. Emergency duties and deaths from heart disease among firefighters in the United States. N Engl J Med 2007;356:1207-1215.

[4]Kang D, Davis LK, Hunt P, Kriebel D,Cancer Incidence Among Male Massachusetts Firefighters, 1987–2003. Am. J. Ind. Med. 2008; 51:329–335

[5] Musk AW, Peters JM, Bernstein L, Rubin C, Monroe, CB. Pulmonary function in fire fighters: A six-year follow-up in the Boston fire department. Am J Ind Med 1982; 3: 3-9

[6]Bars MP Banauch GI, Appel D, Andreachi M, Mouren P, Kelly KJ, Prezant DJ“Tobacco Free With FDNY.” The New York CityFireDepartmentWorldTradeCenter Tobacco Cessation Study CHEST 2006; 129:979–987

[7] Wang CS, Wang ST, Chang TT, Yao WJ, Chou P.Smoking and Alanine Aminotransferase Levels in Hepatitis C Virus Infection: Implications for Prevention of Hepatitis C Virus Progression. Arch Intern Med. 2002;162:811-815.

[8]Leistikow BN, Martin DC,. Milano CE. Injuries, Disasters, and Costs from Cigarettes and Cigarette Lights: A Global Overview. Preventive Medicine, 2000, 31 (2):91-99

[9]Rosenstock L, Olsen, J. Firefighting and Death from Cardiovascular Causes. New Eng J Med 2007; 356:1261-1263

[10]Tobacco Research and Intervention Program. Smoking, Stress, & Mood. H. LeeMoffittCancerCenter and Research Institute at the University of South Florida, 2000

[11]Bars MP Banauch GI, Appel D, Andreachi M, Mouren P, Kelly KJ, Prezant DJ“Tobacco Free With FDNY.” The New York CityFireDepartmentWorldTradeCenter Tobacco Cessation Study. CHEST 2006; 129:979–987

[12]Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008

[13]Ringen K, Anderson N, McAffee T, Zbikowski SM, Fales D. Smoking cessation in a blue-collar population: results from an evidence-based pilot program. Am J Ind Med, 2002; 42: 367-377.

[14]Centers for Disease Control and Prevention. Coverage for Tobacco Use Cessation Treatments. Atlanta: U.S.

Department of Health and Human Services, Centers for Disease Control and Prevention, NationalCenter forChronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2003

[15]Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008

[16]Lee DJ,Fleming LE, McCollister KE, Caban AJ, Arheart KL, LeBlanc WG, Chung-Bridges K, Christ SL, Dietz N,Clark JD. Healthcare provider smoking cessation advice among US worker groups. Tobacco Control 2007;16:325-328

[17]Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008

[18] Bunn III WB, Stave, GM, Downs KE, Alvir JMJ, Dirani, R. Effect of Smoking Status on Productivity Loss.J Occ Environ Med 200648:1099-1108

[19]Leif Associates. Report: The Business Case for Coverage of Tobacco Cessation. [accessed June 4, 2008]

[20] Hodgson, T.. Cigarette smoking and lifetime medical expenditures. The Milbank Quarterly. 1992; 70:81-125.

[21]Reducing the Burden of Smoking on Employee Health and Productivity,” Center for Prevention and Health Services Issue Brief, CDC and the National Business Group on Health, May 2003

[22]HalpernMT, Dirani R, Schmier JK. Impacts of a Smoking Cessation Benefit Among Employed Populations. J Occup Environ Med. 2007;49:11–21

[23]Ringen K, Anderson N, McAffee T, Zbikowski SM, Fales D. Smoking cessation in a blue-collar population: results from an evidence-based pilot program. Am J Ind Med, 2002; 42: 367-377.