December 15, 2022

A Modifiable Health Factor: 5 Considerations Regarding Tobacco Use in Employee Populations

By Healthesystems

Despite significant and continued declines in cigarette smoking prevalence since its widespread popularity in the 1960s, smoking still causes nearly half a million deaths each year and remains the #1 preventable cause of death in the United States. For every death, there is exponential morbidity, healthcare utilization, and costs associated with tobacco smoking.

Recognized as a patient risk factor within workers’ compensation healthcare, cigarette smoking has specific impacts on employee and injured worker patient populations. But here’s the good news: Tobacco use is a modifiable health factor, albeit a complex one that involves physical, emotional, psychological, and even social implications. But with the right programs and support in place, this barrier to good health and good outcomes can be overcome.

Here are 5 things to consider regarding tobacco use in employee or injured worker populations:

#1. Smoking Cessation Programs

Employer-sponsored smoking cessation benefits – such as health insurance coverage for counseling and cessation treatments, worksite cessation treatments, or direct employee incentives for quitting – are more likely to have their employees quit smoking. In turn, these businesses enjoy improved employee health, improved productivity, and lower associated costs. But experts emphasize that the most successful approaches are comprehensive and holistic, treating smokers in much the same way as an employee with a chronic health condition.

#2. Surgery as an Intervention Opportunity

Studies have found that the act of undergoing surgery alone presents increased motivation for smoking cessation. When coupled with an intervention, the likelihood of longer-term behavioral change further increases. While intervention can take shape in multiple forms, digital behavior change interventions (DBCIs), or programs that incorporate text, smartphone apps or games, are showing some success in changing lifestyle behaviors such as tobacco use in the perioperative setting, although more studies are needed. Whether leveraging a DBCI or more traditional approach to smoking cessation, there is an opportunity to intervene in the perioperative setting and potentially reduce the complexity of a claim’s trajectory. 

#3. Occupation

Tobacco use prevalence varies by industry and occupation, with the highest rates among blue collar occupations. Prevalence of cigarette smoking is highest in construction, mining and manufacturing, and smokeless tobacco is used by more than 10% of workers in construction and extraction jobs and nearly 20% of workers in the mining industry, which exceeds the average 3% prevalence across the overall workforce.

#4. Behavioral Health Conditions

There are disparities in how individuals with behavioral or mental health conditions are targeted by commercial tobacco, perceived by healthcare providers, and experience the negative health impacts of smoking. U.S. adults with mental illness self-reported cigarette smoking at a rate 1.8 times higher than those without, at 28.2% and 15.8%, respectively.

#5. Claim Complexities

It is not unusual that a claim with significant therapeutic complexity is influenced by other non-medication factors, among which may be some form of substance use or abuse, including tobacco use. Which is why these cases often benefit from a deeper review of the patient’s complete medical records, rather than a review of medications alone. In an analysis of complex claims undergoing Healthesystems’ intensive clinical review services, a majority of these claims contained data within their medical records indicating some type of substance abuse, inclusive of tobacco use.

For a deeper look at tobacco use as a detractor from injured worker outcomes, see the Rxinformer article, The Triple Threat of Tobacco Use on Employer, Clinical, and Medication Complexity.

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