University Hospitals Health System knows smokers will struggle when a campuswide ban on tobacco use kicks in this November.
So the beefed-up policy, which applies to everyone but carries a penalty for employees caught lighting up on UHHS property, includes an array of options to help workers quit.
In the coming weeks, a free program that combines four sessions of group therapy and a two-month supply of a nicotine patch will be offered to workers. Workers may also access a stop-smoking hot line developed two years ago by the American Lung Association. It is considered one of the most effective in the country.
UH is not alone in its effort to wean employees from an addiction that former Surgeon General C. Everett Koop considered second to cocaine. The Cleveland Clinic Health System will launch a nearly identical policy July 4.
The Mayo Clinic in Minnesota banned smoking in the mid-1990s.
With surveys showing at least 70 percent of adult smokers want to quit, both the University Hospitals and Clinic systems have tried to remove as many financial and geographic barriers as possible.
Along with the free nicotine replacement therapy, which can run between $100 and $120 a month, the sprawling health-care systems offer workers group counseling sessions, seminars and support groups from Ashtabula to Lorain counties.
But, while data from more than 6,000 studies clearly show that evidence-based treatments for tobacco dependence dramatically increase a smoker's chances of quitting, only a few insurance plans cover the full range of smoking cessation treatments. When they do, they rarely advertise the benefit, said Dr. Michael Fiore, director of the University of Wisconsin's Center for Tobacco Research and Intervention.
"It should be as easy to access smoking cessation treatment as it is to go down to the grocery store and buy a pack of Marlboros," said Fiore.
In Ohio, treatment options remain limited. Medicaid, the federal-state insurance program for the poor, pays for nicotine gum, the patch and the prescription drug Zyban but won't cover individual or group counseling.
Starting in July, Medicare, the public insurance program for the elderly, will pay for eight counseling sessions for those with a smoking-related disease like lung cancer or heart disease.
About 70 percent of commercial insurance carriers nationwide provide some smoking cessation coverage.
Meanwhile, a new partnership between the Ohio Tobacco Use Prevention and Control Foundation and several of Ohio's largest health insurers is developing a plan to help 3 million Ohioans quit smoking.
But actions at the federal level have anti-smoking advocates discouraged.
An eight-month civil racketeering case against the tobacco industry may have doomed any chance of widespread assistance for nicotine addicts after Justice Department lawyers unexpectedly decided this month to seek less than 8 percent of the expected penalty of $130 billion. The money has been targeted for smoking cessation programs.
University Hospitals banned smoking inside the workplace in 1991, but the academic medical center known nationally for its cancer program has allowed workers to light up in fiberglass smoking huts sprinkled across the campus. In the dead of winter or the heat of summer, white-coated employees can be seen puffing away.
Using the statewide rate as a benchmark, UHHS officials think about 25 percent of its 20,100 workers smoke.
UHHS decided to ban smoking completely because it wanted to send a better message to the medical community and to patients.
"If a health-care institution like ourselves can't set the example, how can we look at ourselves in the mirror?" said Dr. Michael Nochomovitz, a pulmonologist, president of University Primary and Special Care Practices and chairman of the smoking policy task force.
Striking the right tone was tricky, though. The policy had to be enforceable, but hospital administrators didn't want employees to view the changes as punitive.
So after consulting the Clinic and a health-care system in Michigan that had already gone smoke-free, the hospital decided to offer employees a comprehensive smoking cessation program.
Unlike the Clinic, which in January rolled out an a la carte menu of options ranging from counseling to free starter kits of nicotine replacement, the UHHS program requires employees who want to quit to receive both group counseling and nicotine replacement at the same time.
Studies have shown that combination therapy yields the best results, said Dr. Scott Frank, a Case Western Reserve University professor who studies and treats tobacco dependence.
Forty percent who used this approach managed to quit for at least a year compared with 10 percent to 15 percent who relied strictly on one of the Food and Drug Administration-approved remedies and 1 percent who took the "white-knuckle approach" and quit cold turkey, said Frank.
"The dilemma around smoking cessation has always been that you can offer programs that are effective, but getting patients to attend them is hard," said Frank, a member of UHHS' smoking policy task force.
"It takes time and commitment, and people have the perception that they can do it themselves, even after failing seven or eight times. My message for smokers is to set themselves up for success."
To reach this Plain Dealer reporter: rmcenery@plaind.com, 216-999-5338
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