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Interagency Committee on Smoking and Health

Meeting Summary: March 5, 2007

Reducing Exposure to Secondhand Smoke

Making the Business Case for Going Smoke-free: Roundtable Discussion

Moderator: Kathryn Phillips Campbell, M.P.H., Manager, Center for Prevention and Health Services, National Business Group on Health

Prior to introducing roundtable speakers, Ms. Phillips Campbell gave an overview of employer opportunities in the area of tobacco cessation including:

Because of the enormous economic burden of tobacco use—in human, healthcare and lost productivity costs—there is a clear benefit to providing prevention and treatment support through the workplace. The National Business Group on Health conducted a survey of employees and employers in large U.S. companies and found that 67% of the 508 companies surveyed had established smoke-free workplace policies and 40% offered some kind of cessation benefits.

To help support purchaser decision-making in all areas of preventive medical benefits, the National Business Group on Health and CDC collaborated on a guide that includes a comprehensive cessation benefit with recommendations for screening, counseling and treatment.

Following her remarks, Ms. Phillips Campbell introduced the roundtable presenters.

Donald F. Behan, Ph.D., Senior Research Associate, Center for Risk Management and Insurance Research, Georgia State University

Dr. Behan presented research conducted with colleagues Michael Eriksen and Yijia Lin on the economic effects of environmental tobacco smoke. The study, sponsored by the Society of Actuaries, found that exposure to environmental tobacco smoke is responsible for annual costs of $10 billion in the U.S. and while the number of people exposed and the level of exposure are decreasing, the cost per case is increasing. After describing how the research was conducted, Dr. Behan discussed the public policy implications. He and his colleagues found that exposure is down to a greater degree than can be explained by reduced smoking which indicate that smoke-free regulations seem to be reducing secondhand smoke exposure. However, people in certain occupations—particularly those who are low income—are exposed at a higher rate. Finally, children of smokers are exposed to a greater degree than adults and since these children do not benefit from smoke-free business regulations they are primarily exposed in the home.

Janet Lewis, M.B.A., Senior Manager, Marketing Partnerships and Sponsorships, Starwood Hotels & Resorts Worldwide, Inc.

Ms. Lewis began by describing the decision behind the creation of the Breathe Westin smoke-free initiative. She explained that the idea was developed as a result of the company creating a new brand positioning and conducting consumer research that found that 92% of Westin guests request a non-smoking room and do not smoke in any part of the hotel during their stay. The company also took into account the effect that a smoke-free environment would have on employees' health and work environment and other financial factors.

The idea for the initiative was presented in April 2005 and only eight months later the decision was publicly announced. In that eight months time, it was important that Westin involved its general managers early in the process and the company also had to communicate clearly with guests who had booked rooms in advance. There were other issues that had to be considered including a huge potential revenue loss due to advancing bookings, cigar bars that would have to be closed, and costs associated with the conversion of smoking to nonsmoking rooms. There was an additional issue related to how best to enforce the policy.

Ms. Lewis concluded her remarks by describing the overwhelmingly positive outcome of the Westin policy. She said that the decision was the biggest single public relations event the company had experienced and it has led to the implementation of similar policies in Westin hotels in Fiji, Australia and Scotland.

Jonathan Rosen, M.S., C.I.H., Director, Occupational Safety and Health Department, NYS Public Employees Federation, AFL-CIO

Mr. Rosen talked about the importance of partnering with labor unions and some of the keys to successful collaboration based on his experience in New York. Since 1985, the Public Employees Federation has included contract language addressing tobacco use and initially called for study and research on smoking in the workplace, compliance with right-to-know rules, reviewing of procedures involving toxins and the impact of tight building syndrome on employees. Mr. Rosen highlighted one notable success which included the phasing out of indoor smoking in 70 New York prisons over the last few years. Furthermore, the union was supportive of the passage of the 2003 Clean Indoor Air Act, and pushed for increased programs to provide support to smokers who wanted to quit.

Reminding Committee members that unions are responsible for representing both smokers and nonsmokers, Mr. Rosen talked briefly about the importance of ensuring that policies are not punitive toward smokers. Mr. Rosen recommended that public health advocates should work with unions as equal stakeholders and should understand and support ALL their health and safety concerns, not just those relating to tobacco use.

Mr. Rosen ended his comments by talking about a few of the current and future priorities for the Public Employees Federation. He mentioned the challenges involved in implementing smoke-free policies in custodial care institutions as well as the challenges in attempting to have organizations move toward "tobacco less" policies. A top priority is to develop and evaluate a "Quit Smoking" program that leads to a reduction in healthcare costs, improved quality of work life and promotes wellness among union members.

Following the roundtable presentations, Dr. Moritsugu asked that the Committee break for lunch and return for a question and answer period with the morning's presenters.

Nathaniel Cobb, Indian Health Service, asked Ms. Lewis to comment on the response to the Westin Hotel going smoke-free. Ms. Lewis responded that it had been overwhelmingly positive, particularly among employees who disliked cleaning rooms where there had been smoking.

Jared Jobe, National Heart, Lung, and Blood Institute (NHLBI) asked Ms. Lewis whether Westin's policy change had inspired other hotel chains and Ms. Lewis responded that some of the other Starwood brands are looking into a similar policy change.

Jack Henningfield, Pinney Associates, asked Jonathan Rosen to comment on what can be done in smoke-free businesses for people who don't want to quit smoking. Mr. Rosen responded that smoke-free workplace regulations have motivated many people to quit who previously didn't feel ready to do so. He also agreed that for a number of reasons—including lack of insurance, stressful jobs, and working odd hours— that it can be very difficult to motivate some people to quit and it is important that we continue to develop interventions that will help people in these circumstances.

Dr. Henningfield asked a second question of Donald Behan relating to cost recovery, and commented that many businesses really can't realize this kind of recovery due to a primarily young workforce. For example, McDonalds. Dr. Behan agreed with Dr. Henningfield, and mentioned that the primary symptoms occurring in younger people are acute respiratory episodes.

Nathaniel Cobb, Indian Health Service, asked Cynthia Hallett to comment on efforts underway in tribal communities. Ms. Hallett reported that due to sovereignty issues, there are a lot voluntary activities underway.

To followup on Dr. Cobb's question, Cathy Backinger, NCI, asked Ms. Hallett to comment on the status of smoke-free efforts in casinos. Ms. Hallett spoke about a tribe in the Catskills, New York that is soon to open a casino that will be smoke-free.

In response to an open question to all presenters from RADM Moritsugu about whether it makes business sense to go smoke-free, there was a resounding response of "yes!" Jane Moore, Oregon Department of Human Services, added that she was interested in whether presenters also thought it made business sense to offer cessation benefits. Kathryn Phillips Campbell, Business Group on Health, responded by saying that even with a high failure rate in quit attempts, there are significant cost savings from offering such benefits.

Following the question and answer period, RADM Moritsugu thanked the speakers and introduced the moderator for the afternoon panel.


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