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LIoJLwLJJ l1AiL! JJLf1Lli3t Wanted: Smoking Policies for the Work Place By MARVtNIwd'. ICRrsTEtrJ Nonsmoking, programs are good for corporate health and employees, too. mployers arc taking a two- ponged approach to smoking. They are :beginning to adopt no smoking policies in at least part of the work piate. And they ane offering pnograms - , - . I • '.> ti+- • W ,. .=~ ~ELLI'~TESS `~` REPoRT.: accidtat and labsareteism than the typical nonsnwking,employee. To offset thi: rai increased risk, the tanoking', employee would hire to be clearly, rtrore productive than the aonsarolters. Given this, it is irmtrui analym smoking policies in terms of bow well 1 they reduce health risks. Consider the folloi three exatnpla. A do•nothing policy increases the ttisks: prcsau and future, for a given levet'. of 'reoumL A policy in which sxnoking is controlled in 1 the .wrk place, either by banning uin 91 or, part of the offiae or hiring ady, nnonsmokers, reduces thr risks and is potentially aostttiective for asost' businesses. A third alteraative., providing aids, supports andlor subsidies tw help employee smokers to qMit. perhaps as part of broader hea1M promotion and health eduation i programs; may increase the net, profits and reduce the risks for many bus,nesses'but is' probably ltss oost-ellactiwr than banning smoking. Costs of Ignoring , tbr lswe A number ofdevelopntents have taken place in nxent years that tllustrate why a company policy of' ignoring the issue of smolung , in tbe wort place makes little sense for employers. To begin wuh, there is aa, increasingly aatalkr, minority of adults who smoke. At the satne time: the literuure on damate such as respiratory disease to the involuntary smoker, eis growing, thus supporting the incesasing militancy of'noasntokers aa well as ooun, de- cisions tAat nonsmokers are; entitled to a smoke-frse work envinonment.lsEislition iaGlifocatia, Minnesota. Suffolk Coumy, T+I.Y.. and a frowing, twmber of oommunities around tliie oountry limits smoking in public plaees and pmvidts for smoke-free work places for -titose who ~naquest dtem. The costs ofa do-nothing policy, in terms'of smoking. are huning employers. Recent research shows that, the costs ofsmoking,empioyees'to business arrS30D to $3'50 per average smoker per year at a, minimi These costs includr only shon-term losses that affect employers such often with ash incentives - w aid smoking employees to quit. Therr is some evidence thu. both these types of programs may be profitable for the companies involved, and certainly for society. These steps arr attractive to employers concerned about health ats. particularly if, tthe costs of smoking to business are altulated. They also are attractive to em. playera aoncerned about occupational risks and suits brought by nonsmokers desiring a safe working environment. The business of Dusiness is to make snonelr. F'utaneial ofticers are trained to adoqe r risk-return attitude to making tncney. The.objectiwe is to ataximize return for any given risk and to reduce the tisks associated with any given rtturn, lncreasingiy. companies ate becoming concerned with the potenuia!'aostrof high risk employees. The typical heavy >qmoker consuming aate thin a prck a day is tvnning, a 20 percent lifetime risk of respiratory disease and a 35 to 40 percent lifetime 1 risk of Aeart atnck., stroke and other ardioxaseular problems. iFon persot~ age 30 to 19, State Mutual' Lik Insurance Company of America found smokers have r 1:3 gtenter' ratr of death fnoen al( causes than do nonsmokers.' 7bis analysis is a matter of ' averages. Msny smokers live long and productive lives. Many are gifted; brilliant, hard worlung and rarely illl Nevertheless, the qaestion for the oorporate, planner and policy maker is one of ritk-r+dum. Thrty,picallsmoker is at much higher risk for serious illness,,prantture dath,, Manin M. Krisrein is a prvjessor in the deparr+nerus of economics, and conununiry, and preventive aerdioinr at State IYniyersicy of New Ybr# ar Stony erook'. and ai consultant to rhe AMrnicmn Health fowdarion in New York , Ciry. PAGE 14' M-31

. BuSiNEss AND HEAtM as fin, accidrnts„ ventilation, ckaning, productivity and occupational health risks. One L.os Aageks'eompany'es- timates production losses alone at S67S per smoker per year: Adding longer term costs such as absenteeism. premature mortality and illness would min the total to at Ieast Si,000 per year for eaob atnoker.3It is eurious, given these cost estimrtes, that company policie.cdealing,with smoking largely have besa ia,response to occupational l risk; safety, product eleanliness; customer contact and office appearance, and not to employee health, productivity and health ane costs. For eaample. Campbell Soup's company-wide no smoking policy was started more than' 3q 1 years ago to promote product cleanliness. U covert both production line and office employees to make it an equitable policy for all~ Campbell workers. In reretu years, the eompany expanded'its health promotion program to include subsidies for smoking cessation classes. The history of lohns-Manville Corp. provides a ksson in, the importance of heeding the telatiottship between an occupational' risk and smoking. The surviving Manville Corp, (7iohns-Manville went into bankavptcy in 1993 I!' a consequence of the asbestos nelated! health are claims of its employees) currently forbids smoking in relevant i parts of the work place. The company also lutjes only nonsmokers andd has fired employees who do aot' obey no smoking rules. Given tbe synergistic relationship between amoking, asbestos exposure and lung disease, if Johns Manville originally had followed such a oompany-wide no tanoking, policy, the actual risk of wng disease to etrtployess migltt have been reduced by over 90 percent! Asbestos related lung disease is highly rdated to smoking. Aabestott worliers who smoke have I I times ehe risk as nonsmoking asbestos workers. A company does not have to be in, the asbestos business for its employees who smoke to be au increased risk due to work place exposures. The synergistic effects between smoking and occupational exposures are significant for industries iavolwing, a, wide range of dhemicals, ra- dioactive materials and metals u well. An increasing number of eontpanies: largt and small, are coming to the conclusion i that the costs of a wdl- designed and carefully implemented corporate progrnni an decrease the risks and costs associated with ttnwking.. Three Gannett newspapers in Maine and Boeing ane among the employers that recently instituted no saaking'polieies. Also retlecting employer preferences is that employment agencies report an i increasing demand for nonsmokers. Most companies, nevenheless, have not adopted a policy about smolinc. Sonnc aro reluctant to ittaitttte a smoking policy bec: se they are too dependent on their brsiness rclationships with the tobacco and tobacco related companies and do, not want to aruagonize them. In such cnses, a company does, indeed, need to be cautious about adopting, a no smoking, policy. But this does not free management from its responsibility to respond to the I continuing pressure from nonsmoking employees'. Another situation in which it is di'fficult, - and in, NOVE-NPBE:4, 1984 aotne cases itaposstble - to institute a company policy agaittst smoking is if a significant number of the company's leading executives andlor key snperrisory' employees are committed tanoken. Nothing can be accomplished in, a company tmlbss top management really wants it. The office dynamics aiitigating against instituting ao smoking policies ant: likely to change as younger people rise to poshions of authority. Statistially, them are fewer people, particularly aten, age 30 to a0 who are txaoken in contrast to people age 50 to 160. It also malr• be that as more and nwrt: evidence is developed about, the profitability of no smoking policies, stockholders of public companies with aesistant top management will have the clout to introduce such measures. Objections (werruled! The majority of eompanies that have not implettwented' no anaking, policies are basing their reasoaing in large part an onttlated information aadc basic ignorance of the issues involved. Relatively few of these companies have evsa i thought, aerioualy about it. TAtis. howe+rcr, is likely to change. The published evidence on the strroking, health and work ptaet interaction has greatly expanded in the Last few years along with siinificant changes in public 1 attitudes. Monatnokers. for e:ample, see themselves as a, majority, and morr and more are demanding smoke-ftee environments. Court decisions and state and local! legislation reflect these demands. Recent actions by the tobacco indluuy uself,' in, tnrms of diirenifiatioa and I promoting sales to foreign markets; indicate a basic acceptance of a lost, cause position. Even, the tont: of recent tobacco advertising recognizes that smoking is not for everyone. While these are all positive and uscful steps towards developing a nonsmoking policy, there is also a lag time of' several years before business kadcrs will begin to respond affimutively. Some companies arr aware of the health problems M-32 PAGE 15'

BusmES&ANU HEALTH CGompany Activities In Smoking Control 3 Fifteen years ago, 78 percent of the population teit dnt managers should' have the right to prohibit stnoking, in their place of business. Now the desire for a smohe- frbe work p,lace is rery much a teality aad extends beyond the traditional boundaries of atanagerttau-labor. aaployRr, employee and white oollar-bloe collar ootteerre;. .. -•: : A review of the liuratureand current sxaau of attoking , control activities suggests that workaite programs have ~ a unique potential to tach those workers who smoke and turdenuilile existing smoking cessation services. As Carok T. Orleans and Robert H. Shipley of Duke University, Medical Center point out in, their tesearrlt. work piace social supports an providb : nonsmoking norms and n.in. forcement to help maintain lasting, changt: : in smoking be - ' hawior: , - Bange' of Approaches Cormpany activities to control uttoking, in the work place range from policies restricting satoking,in designaud aneas, to completely banning smoking at tfie :woeksite. to offering smoking cessation progLVas. Scese an,ployers'pnoo- vide incentives foremployees'who yuit'stnoking that inditde ~ cash and other~ tangible rtwards; as weA as social tein+ fottement through personal recogttition, praiseand company sporuored'conttsts. Smoking casuion suategia may vary deperding on the number of etnployees.,their smoking dehavior, the kind of work performed and the eompaay's involvement in tlle smoking , industry. The Institute on ~Workaite Wellaas of the Washingtoa Business Ghoup on Health, in an ongoing review of'such uruegies, has idetttified several factors contn-buting to suc- oessful smoking cessation programs. One such faetor is that contpany policies are easier to implemenr and less divisive when they ate developed vol- untar6iy. For acample; a study oo employee tatoking', at' Pacific Telesis revealed that 7'out of' 10 (71 percent) of aA enPloyees and over, half'(S1 petceta) of the antokerss would like some type of smoking poliey for ttteirintmed'we, ereated by smoking andlthe eosts of this to their corporate tiudget, but they so far have declined to: develop no smoking policies at the worksite because ~ they view such policies as unenforceable. This, however, is a red hert9ng argument. To : begin with; a policy of no 1 srnolung plus a policy of hiring nonsmokers only comes under a eompany's right: to define the nature of the work place and the appropriate behavior of its employees while at work. This righchas bec* •!n_ held in most legal contexts. For example, the U.S. Equai 3mplbyment Opportunity Commission has held that such a policy does not involve discrimination as long as it is equally' applied! to all employees. Once a company policy is set, most people fiollow. -it: No law; however, is follow,ed perfectly: Think ofispeed limits. A no ismoking policy can neventheless be effective even if'only, 990, percent of employecs follow it. PAG,p lG' work area. About tlirarfotmhs (73 perrent) of all employees would like to have a snaking policy in effect for other arsas at the worksite as well. Six out of 10 (59 percent) would like to iee designated tttttoking and nonsmoking atasi for iastance, in cafeterias and confersttce rooms. . A aeoond tatoass. faotor' is dtat eoatpania that offer ntcentives for stnoking cessatioa realirs the gneatest return on their investment when they provide access to effective smoking stoppage tttediods; that is, those with a proven track record. This is true even when a company's program eonsists primarily of referring smokers to treuments avatil'- able otuside tho , work place. Rodale Press bantxd smokiag in January 1982 for its 350 employees. When a few workers had trouble abiding by the ban, the management encouraged them to enroll in Smok&tders; a'•prirate srtaking txsution program. and Rotlile rdimded the S73'registrationfee as well as paying a SZS bonus to 4toze who stteaessfully quit smoking. . A durd! impmant factor is to precede the offer for cessation treaanent'with eduaticeal campaigns andlor cor- Porate pteswre' or iaoemi'va' to promote quitting. On. Apnl' 1, 1984. dthe Group Health Cooperative of Pltget Sound implitmented its ban on sntokittg,in the work place'for ita'3,OOD employees. This prnhibitiott representss tlie eulhtiaation of rtwo-ycar effort by the,largest Dealth tnaintenattce orpnisatioa in Wathiagton state. Motivated primarly by its mission of wellnas. the smoke-free policy has encouraged most if'at7lt all of its smoking etnployeess tts stttoke kss.and itttanyto t)ttit snroking altogether. Cessation . effiorts of GHC eatplo,yces are supponad by the company duaugfisbe arat'lability of self-help materials and free smok- ing otssation classes. Employees bretking the r les re- peaaedly may erea be fired under tbr new policy,.. At!Ckleatts and Shipley in tlieir mriew fottnd. successful worksite programs hartxss and exploit the ••cltieftberapeutic rssautce - a cohesive sttpport network" with corporate coatiAgenciea rttinforcing', nonsmoking. Srni Fddls,aa, W:shiqgtot. Boid+tess Group on HealtJt The key to appnling to etnployees to comply with ra smoking'pdicies is to introduce policies in a businesslike manner. The point is not to punish or attack smokers.. Employees must understand that the ! no smoking policy involves the riglits of' noesatokers and is ~ designed for the best interests of the company. Introducing a program in such a fasliion is likely to involve little employee opposition or attempts to sabotage it by smoking employees taking an ezcessi vely long time on cigarette breaYs- A arefuily, iintroduced program will cost money. perhaps in the range of $S'to310'per employee for sctting, up the program, arranging employee meetings about the poliey, and promoning it in special newsletters. The om- ployer, however, stands to, get a high rate of return on that investment. For example. suppose a company with 1.000 employees spends 510:000'to introdbce aino smoking NIOYEN'IDER 19'hai M:-33

C LI iW V,. u. r.r,a policy. Based on national avenges, the company will!have 300 smoking emptrnyees, each 1 costing the employer, $300 a year in extra1 expenses due to their, tsntoking. Ifi they stop4 the employer could save 540.000 a year - all based I on, a one .timr capital investment of SIiDlOCDOi Calculating Costs For managers used to dealing with hard numbers - profit and loss, for acample - it is difficult to think of developing', a company policy based on inferences from estimates. Many of them believe that true proal of the nct gain ofiadopting a company smoking policy is missing because there is no tanoking,gun type of evidence that smoking employees involve a net cost to their employers that can be eliminated through nonsmoking policies. While it is true that such evidenee has twot beenn published widely, a number of' companies have internal studies that are firm enough for them to base policy upon. Based on a 20, to 25 percent awccrss tate for Campbell ` Soup. for example, it has been calculated that its antwaf' rate of return for money invested in smoking cessation programs for employees is between 25 and 50 percent. That means that for every S'1' invested, they will earn 25 cents to 50 cents a year.' Other companies thw have reported that smoking eessation iefforts ars cost-effective include Metropolitan Lire Insurance Co.. Dow Chemical Company.lohnson & Johnson. New York Telephooe Ca. Ford Motor Company, IBMI E.l. DuPont de Nemours li Co. and Cyberteck Cotnputer.6In general, the business community anna afford to wait for the nesults of tong,term controlled trials of this' subject. While the data on the eoats of' smoking, arr estimates and infereaces, they arrbased on dinxt!atcdicai cate spending and toss or gross auional product (GIaP). and on epidemiological Istudies connecting eentaiA illnesses to smoking. These estimates are not guesses but represent aggregate c+ost data, time and motion studies and legal taandards. The estimates based on real dollar ettists invdve dividing by relevant population sizes to arrive at per smoker figures. Obviously, not every smoker actually produces the average cost figure, but for every smoker who is not responsible for this average cost there ttwat be a, smoker producing twice that amtwnt. Using figures inflaued'to approxinntr late 1994 dollars, an estimate of the excess medical taosts to the cowary' of smoking (that is, illnesses that would be insignificant if it were not for the fact that people smoke) is $241 billion per year and the loss in GNP, using, nsinintal, human capital values of' life prematurely, lost and ineotne lost due to these avoidable illnesses, is $36 billion per year.' These figures do not include thr eost of pain and suffering and the multiplier effects on family: friends, employers and society of' prematuro disability and death du: too smoking: I Public Health in the Private Sector Major health gains are expected from, instituting, no smoking policies in the work place. Both employers and I the population at large will benefit. In one sense„ it can be artuedl tlut programs ftx public health gains rally. N()1'EMIII:R 1984 fa11'under the aegis of the gwernmenr. 10 fact, employers might not even enjoy the benefits of successful employee smoking cessation programs because of' labor turnover. An employee who had participated in a smoking cessation program in cnmprny A teay wbsaptattty tttove'to company B. Perhaps' the' alrongest' argument against a nation and in some cases a company adopting no anaking policies is thar the net gains ftom them are t:wre than offset by the costs of an increase in the numbers of older persons due to the reduction in ptetnaturs_ trtortality associated with smoking. "The costs. of 'a do-notlhing policy, in, terms of smoking, are hurting employers. Recent research shows that the'costs of 'smoking employees to business are $300 to $350 peir ' a+rdrage' smoker per year.. . . " It' is itonic: diar the ultimate defettse of' smoking involves accepting the most serious actusations against it: thu' is. it aerves to signiftcantly reduce the survival rate of adults so dur the savings in tstiretnent payments tttay be larger thaa the eost and i G11'IP savings while these persons live. If'the fires of retitt~es are valued' at sero, it is cheaper for the society to let them die at a younger age. If'this txoxtmic logic is putstacd further, it would be even more cost-efrettive for the society (and companies paying for employee retirement) to find a, more perfecr means of killing everyone on his or her 6Sth birthday. without producing the associsted illnesses and productivity losses involved with smoking. A fulkr public discussion of this point as a defense for opposing a nonsmcking, policy in the work place aould. in fact, convince more people that such a policy is the only one tfut is morally acceptabk . i Motei. 1! MiD: Ca.ftql sad B.L. Hirst; "Mortality Differences between Snwkrrs and! Nouumoken,.- (company docvment) State Mutual Lire Assurance Co. of An+erica. Woreester, Nfass., Ckt. 22. 1979. 2. M;M. Kristein; ••How Much Can Business Expeca to Profit from Smoking C'tssstion?" 'rmznri++r AYtdicine, 12:358'-3'81. 1987. 7+ D.P. Rice and!T.A. Hod8sonl "E¢onomic Costs of'Smokintt An i A+wlysis of' Data for the U.S.,•• presented at the Allied I Social Science Assarciation amud meeting. San Francisco. Calif.. Dec. 28. 1983. - - C M.Mi Krittein, "Asbestos Workers and Lung Cancer." Awaniton lorenal'of rrblie Nealth 71:'J+/09. 1981',. 5. Ktistrin. op. cit. 6. R.S. Parkinson n sl, Mvnctin= Mtalrh Pranaion in the Wortplarr (Palb Alto. Calif.: MayfieW Publiahing Co~. 1982). 7. Rice and Hodpon. op., cir. M-34. . ~_;