1. Barbara Silver, MA, CTTS, Carol Ripley-Moffitt, MDiv, CTTS, Jillian E. Harris, BASW, Mark Gwynne, MD, Adam Goldstein, MD, MPH Nicotine Dependence Program (NDP), University of North Carolina Department of Family Medicine, Chapel Hill, NC TOBACCO FREE TAR HEELS: Outcomes and lessons learned from employee cessation programs at UNC Health Care System and the Town of Chapel Hill

2. FUNDING SOURCES The UNC Health Care System provides funding for its employee Tobacco Free Tar Heels program The Town of Chapel Hill contracts with the UNC Department of Family Medicine’s Wellness@Work program, which includes employee tobacco use treatment

3. OBJECTIVES 1. 1. Describe two models of employee tobacco cessation programs 2. 2. Discuss challenges and facilitators for each program 3. 3. Examine impact of free medications and incentives on enrollment, participation, quit attempts, and abstinence rates

4. SUMMARY LITERATURE SUMMARY  Workplace interventions targeted at individual employees increase the likelihood of quitting smoking. (Cahill, Moher, M., & Lancaster, 2008)  Incentives (cash, prizes, decreased health insurance premiums) increase enrollment in treatment programs but do not increase quit rates. (Cahill & Perera, 2011; Hennrikus et al., 2009)

5. PROGRAM IMPLEMENTATION: UNC Health Care System (UNC HCS) Tobacco Free Tar Heels (TFTH) Jan. 2010 pilot program; full program implemented Jan. 2011 One.55 FTE tobacco treatment specialist &.02 FTE physician Partners: UNC Wellness Committee for promotion & incentives Department of Family Medicine (DFM) IT for database development UNC Outpatient Pharmacy for medications & billing

6. : PROGRAM IMPLEMENTATION : Town of Chapel Hill Employee Tobacco Free Program July 2011 UNC DFM Wellness@Work contracted with Town of Chapel Hill (ToCH) to offer employees Health Risk Assessment, labs, and management of weight, diabetes, hypertension & tobacco use UNC NDP provides tobacco use treatment services with.25 FTE tobacco treatment specialist Added tracking for medications received & distributed to Access database

7. ORGANIZATION COMPARISON HospitalTown Eligible Employees7618681 Average age42 Race Caucasian57%56% African American25%37% Gender Female74%33% Male26%67% Estimation of # using tobacco 1143136

8. COMPARISON OF MODELS Program ComponentHospitalTown Max # counseling sessions*9Unlimited Free cessation medicationAll FDA approved** Patch, Gum, Lozenge*** Sources of medicationPick up hospital pharmacy Distributed at visit Follow-up surveys3, 6, 12 month Incentive for completing surveys$5None Incentive for abstinenceNone$100 at 6 & 12 months for continuous Incentive for referring others$5None *Sessions include in person, phone, and email. ** Except nasal spray ***Began 5/1/2012

9. FUNDING MODELS HospitalTown Medications Hospital reimburses pharmacy Grant from BCBS Medication cost per employee $85$92 Counseling.55 FTE TTS.25 FTE TTS Other costs Cell phone, CO monitor & supplies, mileage, bookmarks/publicity, IT support Funding $150/initial; $30/per f-u (limit 8) per FY 25%of TTS salary

10. PARTICIPANTS Hospital (n=138)*Town (n=58)* Average age4144 Gender 70% Female74% Male Use of smokeless tobacco 3%26% HS diploma/some college 64% Associate/College degree or higher 34%31% Race Caucasian59%52% African American32%43% *1/11-9/13 **7/11-9/13

11. MEDICATIONS

12. QUIT RATES (Intent To Treat, 7 Day Point Prevalence ) HospitalTown 3 months39%41% 6 months27%35% 12 months22%33%

13. FOLLOW-UP SURVEY COMPLETION

14. AVERAGE NUMBER SESSIONS at 12 months (in person, phone, email)

15. RETURN ON INVESTMENT Estimates for ROIHospitalTown # employees who smoke/use tobacco1143136 # of program participants in given year5024 # who quit 3mon.2010 # who quit 12 mon.118 Cost of program*3975625984 Cost savings (# quit x$3856**)3 mon. quit7712038560 Cost savings (# quit x$3856)12 mon. quit4241630848 ROI (Savings/cost) 3 mon quit1.91.5 ROI (Savings/cost) 12 mon quit1.11.2 *does not include inkind **CDC annual cost to employer MMWR200857(45);1226-8

16. LIMITATIONS  Quit rates are self-report (except for Town of Chapel Hill where CO monitor used for 6 and 12 month incentive)

17. CHALLENGES AND LESSONS LEARNED Communication Email reminders of appointments Email reminders of appointments For those with no email, phone calls or texts For those with no email, phone calls or textsScheduling Make “house calls” to outlying centers and departments Make “house calls” to outlying centers and departments Flexibility in meeting patients – come in early or stay late Flexibility in meeting patients – come in early or stay lateModels Need for tailoring interventions for specific employee populations Need for tailoring interventions for specific employee populations

18. CHALLENGES AND LESSONS LEARNED  Medication adherence At each communication – phone or in person – emphasize proper and continued use of medication At each communication – phone or in person – emphasize proper and continued use of medication Giving NRT at visit vs picking up from hospital pharmacy Giving NRT at visit vs picking up from hospital pharmacy  Keeping patients motivated Celebrating even the small successes Celebrating even the small successes Reviewing original motivations and strategies Reviewing original motivations and strategies  Costs

19. CONTACT INFORMATION Barbara J. Silver Barbara J. Silver barbara_silver@med.unc.edu 919-445-5358