June 18 -19 2009 Sponsored by Hyatt

June 18 -19, 2009 Sponsored by | Hyatt Regency Chicago

American Cancer Society Workplace Solutions: Using Evidence Based Strategies to Focus on Chronic Disease Prevention among Your Workforce Jeff Cross, MPH Workplace Solutions Products Manager American Cancer Society

1. Background Today’s Topics Ø Health Effects Ø Trends Ø Costs 2. Solutions Ø Workplace Policies Ø Employee Health Promotion Programs 3. How ACS Can Help Ø Tobacco Cessation Ø Weight Management

Cancer is the #1 cause of death among working-age adults in the United States. • One-third are caused by tobacco use. • One-third are related to overweight/obesity, physical inactivity, and nutrition. “Two-thirds of cancer deaths can be prevented” --John Seffrin, CEO , American Cancer Society

Prevention Reduce population risk for cancer and other chronic diseases using evidence-based strategies for changing health behaviors. • Quitting tobacco • Being physically active • Eating well • Getting screened for cancer

Cancer #1 Cost For Employers

Why ACS? Value Reputation – Mission-driven – Non-profit cost structure drives cost-effective program design and delivery – 98% name recognition – Research-centric: discovery and dissemination Reach – Local: 3, 400 offices in the United States Cause – Cancer is the leading cause of death of working -age Americans – Global: operate in Asia, Africa, & the Americas – Fast-growing threat to public health, globally

Mission Match Improving health behaviors reduces cancer risk and directly benefits employers’ bottom-line ACS has expertise in achieving health behavior change

Problem Underuse of effective treatment Ø 80% of smokers who attempt to quit do so without stop-smoking medications or any other method of assistance. Ø 75% of people trying to lose weight do so without combining diet and exercise.

Health behaviors occur in context Context Workplace Practices Health Behaviors Target Outcomes Benefits Tobacco use Health Policies Physical activity Health care costs Programs Fruits & vegetables Productivity What your company does (or doesn’t do) defines the context.

Evidence-base What is “evidence-based”? • U. S. Task Force on Community Preventive Services http: //www. thecommunityguide. org What is the Community Guide? • “recommendations based on the evidence gathered in systematic scientific reviews of published studies…”

Workplace Health Promotion Best Practices “TOP 15” Five Categories Benefits Policies Programs Tracking Communication Four Behaviors Tobacco cessation Physical activity Nutrition Cancer screening & care

Aligning Policies Effective policies: 1. Directly influence behavior change 2. Facilitate use of effective treatment for behavior change 3. Support maintenance of behavior change Advantages • Low-cost • Long-lasting • Leverage existing benefits & programs • Reach entire workforce • Goal is to align policies to support target behaviors

Tobacco Cessation

Tobacco Use Trends 19. 8% of Americans currently use tobacco Tobacco use among adults employed Full time: 29. 1% Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System (BRFSS) 2007. Available at: http: //www. cdc. gov/brfss

Tobacco Policy Trends

Cost of Tobacco • Treatment for disease caused by tobacco • Exacerbates disease not caused by tobacco • Decreases treatment effectiveness The estimated difference in average annual medical expenditures between smokers and non-smokers is $2, 583 per tobacco user. Source: Centers for Disease Control and Prevention. MMWR — Cigarette Smoking-Attributable Morbidity — United States, 2000 September 5, 2003 / Vol. 52 / No. 35

Productivity • Tobacco-related work productivity loss is $1, 200/tobacco user/year based on smoker versus non-smoker differences in: • Absenteeism of 3 days/year • At-work productivity of 10 minutes/day, attributable to excess break time • Total time loss of 67. 5 hrs/yr is multiplied by $17. 77/hour, the current national average hourly wage. Source: Warner KE, et al “Health and Economic Implications of a Work-Site Smoking Cessation Program: A Simulation Analysis” JOEM 1996; 38(10) 981 -92. Data are from the National Health Interview Survey. Halpern MT. “Impact of smoking status on workplace absenteeism and productivity” Tobacco Control 2001; 10: 233 -38. Bureau of Labor Statistics, Mar 2006 USDL 07 -0486. http: //www. bls. gov/news. release/empsit. nr 0. htm

Tobacco Cessation Solutions Ban tobacco use at worksites • Reduces ETS exposure by 72% • 3. 8% reduction in smoking prevalence • Reduces amount smoked by 3. 1 cigarettes per day Provide full coverage for tobacco cessation aids • Increases quit attempts by 7. 0% Increases # of quitters by 7. 8% Require plans to send reminders to network providers • Increases # patients who receive advice to quit by 20% • Increase # of quitters by 4. 7 percentage point. Sponsor telephone counseling • Increases # of quitters by 41%

Policies that Work Tobacco-free Smoking bans prohibit smoking entirely; smoking restrictions limit smoking to designated areas. Critical aspects of the policy: • Must be written & posted • Link to values and business strategy • Indicate where smoking is prohibited • Specify enforcement methods • Eliminate breaks for smoking • Provide support for smokers to quit Effects: • Reduces environmental tobacco smoke exposure by 72% • Reduces prevalence of smoking by 3. 8% • Reduces amount smoked by 3. 1 cigarettes per day Source: Fichtenberg CM, Glantz SA. Effect of smoke-free workplaces on smoking behaviour: systematic review. British Medical Journal 2002; 325(7357): 188.

Policies the Work: Reminders Provider reminder systems identify patients who use tobacco products and prompt providers to discuss cessation with them. Implementation: Health plans administered Effects: Because even brief provider advice has a demonstrated effect on getting clients to quit, provider reminders: – Increase # patients who receive advice to quit by 20% – Increase # of quitters by 4. 7 percentage point.

How ACS Can Help

Weight Management

Obesity Trends* Among U. S. Adults BRFSS, 2007 *BMI ≥ 30, or ~ 30 lbs. overweight for 5’ 4” person No Data ≥ 30% <10% 10%– 14% 15%– 19% 20%– 24% 25%– 29%

Current Trends Risk Factor Prevalence (%) 2005 2007 Obesity 24. 4 26. 3 Overweight 36. 7 36. 6 48. 7 49. 2 23. 2 24. 3 Physical Activity (30 min/ day x 5/wk) Nutrition (5 fruits & vegetables per day)

Obesity & Mortality • Fastest growing cause of death, globally. • About 350, 000 deaths are attributable to obesity each year. • About 1/3 of all cancer deaths can be prevented if we eat well, are physically active, and maintain a healthy weight. * SOURCE: CDC, ACS Facts & Figures

Cost of Obesity • Excess costs for obesity: $10 K person • Approximately onethird of all medical costs for overweight and obesity in the United States are paid by employers. SOURCES: Finkelstein, EA, Fiebelkorn, IC, Wang, G. National medical spending attributable to overweight and obesity: How much, and who’s paying? Health Affairs 2003; W 3; 219– 226.

Weight Management Strategies Point-of-decision prompts • 54% increase in stair use Enhance access for physical activity • 25% increase in adherence to PA guidelines Make healthy food choices available and • 300% increase in fruit & salad affordable purchases when prices cut by half Individualized goal-setting • 35% increase in time being active; Non-family social support • 64% increase in energy expenditure Multi-component programs for weight management • 5 -25 pound weight loss per participant Source: US Task Force on Community Preventive Services. www. thecommunityguide. org

How ACS Can Help

ACS Workplace Solutions to help your Employees Quit Tobacco Shelley Mac. Allister Tobacco Cessation Products Manager American Cancer Society

Facts About Quitting • Most smokers say they want to quit (70%) and, each year, nearly half make an attempt (44%). • Without help, less than 5% of smokers quit successfully. With help, quit rates are 2 -10 x greater. • The limiting factor is use of effective treatment. • Availability, affordability and awareness drive utilization.

ü Evidence based tobacco group support program ü Motivational intervention activities ü Education about medication and approaches to quitting ü Social support

ü Industry leading program ü Proactive counseling with highly trained professionals ü Pharmacological support assistance ü Promotional guidance services

Quitline Clinical Trials Past trials: – Dose response trial – Beck Depression trial – Fax referral trial with Virginia Commonwealth University – Dyadic Efficacy trial New Trials: – – E-mail study Reactive session Depressive mood assessment Health care provider referrals

American Cancer Society Quitline— an Industry-Leader • Brand • Price • Experience • Support • Results • Reach

Quitting • Cessation treatments more than double a smoker’s chances of quitting successfully. • Combining counseling with medication yields the highest quit rates. Treatment Quit Rate Quitline with medication 28. 1% Varenicline (Chantix®) 25. 4% Bupropion SR (Zyban®) 24. 2% Nicotine Patch 23. 4% Nicotine Gum 19. 0% Quitline (counseling only) 12. 7% Self-help 8. 5% SOURCE: 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.

Account Support • Nationwide Field Staff – We have dedicated staff across the country to help your program succeed • Quitline® Account Management – Located at Quitline operations site in Austin, TX – helps with initial launch and provides ongoing assistance

Commitment to Effective Utilization • Initial program design is important • Removing barriers increases utilization and satisfaction with service • Monthly utilization reports include how heard responses to gauge success of promotional strategy • We offer state-of-the-art Print on Demand service that allows free co-branding of all promotional items Successful Quitline programs include strong program design and consistent promotional strategy

Sample Print On Demand

Workplace Solutions to help your Employees Manage Weight Heather Adams Nutrition & Physical Activity Products Manager American Cancer Society

Facts About Weight Loss • 28% of the population is actively trying to maintain their weight, 33%-40% of women are trying to lose weight and 20% -24% of men are trying to lose weight • Concerns about future and current health, fitness, and appearance were cited frequently by survey respondents as the most important reasons for trying to lose weight • Successful weight loss programs incorporate realistic goals and lifestyle changes, behavior changes should be comfortable for people to adhere long term Source: National Library of Medicine: http: //www. ncbi. nlm. nih. gov/books/bv. fcgi? rid=hstat 4. section. 24813

A Worksite tool for planning healthy meetings and events ü ü Quick, easy, and affordable ideas to energize business events General tips for healthy meals and snacks Advice on working with a facility chef or caterer Tips on how to incorporate physical activity into meetings

ü Provides completely automated program delivery ü Generates comprehensive reports ü Allows benchmarking and measurement of behavior change ü Provides commercial quality product provided to you at no cost

ü Innovative, evidence based weight management program ü Based on a two year research study, involving 50+ companies ü Telephone based counseling service ü Focused around five strategies: • • • Stimulus control Self monitoring Cognitive restructuring Stress management Social support

Self-Reported Change in Weight 35. 0% 31. 7% 30. 0% 26. 1% 25. 0% 20. 0% 18. 8% 13. 1% 15. 0% 10. 0% 5. 0% 0. 0% 4. 6% 7. 2% Participants classified as overweight or obese at baseline 3 months 6 months 12 months 10% 5%

ROI Potential Obesity Prevention • Nearly 100% weight maintenance among normal-weight participants • Avert future increase in obesity-related costs ($10 K) Weight Loss • 31% of overweight/obese participants maintained at least a 5% weight loss at 12 mos. 13% reported at least a 10% weight loss. • Returns of $2, 200 to $5, 300 person SOURCES: National Heart, Lung, and Blood Institute. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults, 1998. pp. 1 -228. The Economics of Obesity A Report on the Workshop Held at USDA’s Economic Research Service

1. 60 1. 40 Change in Fruit/Vegetable Consumption 1. 15 1. 20 1. 00 1. 44 1. 43 1. 39 0. 96 0. 94 0. 80 0. 60 0. 40 0. 20 0. 00 3 months Counseling Self-Help 6 months 12 months

Materials & Online Tools

For more information, please visit www. acsworkplacesolutions. com or call us at 800 -ACS-2345 Sponsored by