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Smoking in the Workplace

By Dr. Shafiq Qaadri, MD

Twenty years ago, every desk came with an ashtray and non-smokers were the outcasts of the office. Now, workplace legislation, lawsuits and rising health care costs have forced smokers into designated rooms or outside.

"I worked at a hospital for five years," says Glenville Edwards, 60, a lung-cancer survivor.

"They never said anything as long as I smoked outside the perimeter."

But that's not enough. Smoking is the leading cause of preventable disease and employers need to join doctors help smokers kick a habit that's more addictive than heroin. Cigarettes are a perfect addiction: They are powerful, portable, available, and with each self-administered hit, nicotine is delivered to the brain in seven seconds. Whether gold-tipped, wine-dipped, filtered, king-size, ultralight, menthol, smooth or silky, a cigarette is an ideal drug-delivery system, acting faster than an injection of heroin.

Doctors cannot compete, seeing smokers only a few times a year, and the cigarettes and nicotine are winning.

There are five million smokers in Canada's work force, and each day physicians have to deal with the results, including impotence, poor leg circulation, heart attacks, strokes, chronic cough, emphysema and various cancers.

And consider this: The dollar-costs of smoking are staggering, so the case for comprehensive quitting strategies is not only medical but also economic.

"There is a significant burden of health costs," says Graham Lowe, a sociologist at the University of Alberta and author of Workplace Smoking: Trends, Issues and Strategies.

"It's a public policy issue."

Smokers cost Canadian society $15-billion -- $4,000 each -- annually in expenses related to health care, absenteeism, insurance, fires, worker's compensation, disability and premature death. As Dr. Lowe states: "There is a good return-on-investment of smoking-cessation programs for employers and for society."

Greg Petrosian, 63, smokes 50 cigarettes a day. Greg is terrified of quitting smoking, knowing he couldn't continue his daily routine while weaning himself off nicotine. In fact, when trying to quit, nicotine-addicts such as Greg may experience withdrawal symptoms that include sweats, irritability, insomnia, headache, fatigue, cloudy thinking, depression and even panic attacks.

Most smokers are accomplished quitters, having done so many times. "I quit after my second bypass surgery," says a 53-year-old taxi-despatcher. "I smoked because of the stress at work and to stay awake."
And it's not just smokers who suffer. "My asthma gets worse at my job," says 42-year-old Marilou Gastaya. "I work close to the smoking room."

Last week, Ontario's Workplace Safety and Insurance Board awarded compensation to a former waitress -- a non-smoker with terminal lung cancer. A board spokesman said it was the third case of compensation offered for disability from second-hand smoke in the workplace.

And earlier this year, British Columbia's Workers Compensation Board allowed a claim from a woman who filed for disability because she developed breast cancer working in a smoky workplace.

So what can companies do?

Sponsor stop-smoking program, such as EASE, Smokenders, Smokeless, STAYWELL, Quit Club and Fresh Start. These programs use self-help books and tapes, mailings, group classes, monthly seminars, telephone-nagging, retreats, competition between work groups and counselling by physicians and lung-cancer survivors.

For example, Dr. Forrest Fisher, corporate director of the Campbell Soup Co., selected Smokenders for his employees, appreciating the structured components of the program, such as assignments, attitude management, buddy groups, positive reinforcement and lectures on addiction. The company has had reasonable success with its in-house program.

Cover prescription and over-the-counter nicotine replacement.

A drug addiction is often treated with a drug, and there are nicotine replacement patches, pills, gums and inhalers. But these nicotine substitutes must be combined with active management, advice and monitoring.
Nicotine replacement "is helpful with withdrawal symptoms," says Dr. John Pierce, a researcher with the Cancer Prevention and Control Program at the University of California, San Diego. But unless smokers are guided through their cravings, "people are going to go back to smoking . . . It's a psychological addiction too."

Pay smokers to quit.

It Pays to Stop Smoking is an initiative some U.S. firms have instituted to encourage workers not to smoke, as it is cheaper for the company health plan. For example, one firm pays its workers $400 to give up smoking, and has spies tracking the ex-smoker's compliance. The company fines workers if they start to smoke again, though it cannot fire them.

Allow employees to have time off to get through the withdrawal or go to detoxification centres.

Employers must recognize that a major nicotine addict cannot continue his civilian life while fighting such a powerful chemical dependency. With a physician's referral, the would-be quitter should have access to a detoxification centre.

Debbie Caissey, 42, is an unrepentant pack-a-day smoker. But she likes the idea of a workplace smoking-cessation program. "I would enroll if it was available. "Maybe it would help me."

So what about employers' concerns about these ideas?

Cost: American companies distribute the costs of smoking-cessation programs across all employees, reducing each worker's contribution to a few cents. Progressive Canadian employers subsidize costs: Dr. Robert Kingstone, occupational health director at ICI Canada Inc., says his company reimburses its workers for attending quitting-programs.

But program costs should be tax-deductible, as an incentive to workers and corporations.

John Wilkinson, a financial benefits consultant to employers, has run the numbers. "There is an economic argument to be prophylactic about health. . . . Smokers cost more." For example, Monica Belcourt, a professor of human resources management at York University, notes that cigarette breaks cost employers 18 days of work per smoker annually.

Size: Companies with fewer than 100 employees claim they do not have the resources for in-house programs. Yet the majority of smokers work in smaller companies: According to Physicians for a Smoke-free Canada, the highest proportion of smokers work in forestry, mining, transportation and construction. Nevertheless, the federal Health Promotion and Protection Branch is working on "models to help employers create healthy work-environments."

Loss of business: Hospitality and recreational establishments continue to argue that smoking bans reduce patronage. But according to the World Bank, a complete smoking-ban in public spaces actually increases business.

Dr. Lowe hopes that Canadian work sites become "a venue for promoting health and wellness," and there are compelling medical and financial arguments for this. He has called the reduction in public exposure to smoke "one of the major public-health successes of the past two decades."

There has been much talk in business literature about investing in human capital, teaching new skills-sets, new business models, Total Quality Management. But so far, smokers have only been legislated, isolated and ventilated.

Dr. Shafiq Qaadri is a Toronto family physician and Continuing Medical Education lecturer. www.doctorQ.ca

By the numbers

10:The number of minutes of life lost per cigarette.
40:The number of cancer-causing chemicals in smoke.
50 billion:The number of cigarettes sold in Canada yearly.
$15-billion:The amount the Canadian economy loses yearly because of smoking.
$4,000:The amount lost per smoker in the work force.
5 million:The number of smokers in the Canadian work force.
50 million:The number of smokers in the United States.
30 per cent:The breathing capacity lost by a pack-a-day smoker by age 50.
25 per cent:The proportion of family income spent on cigarettes in China.
100,000:The number of Canadian teenagers who take up smoking yearly.
19,000:The number of Canadians who are diagnosed with lung cancer yearly.
$80,000:The amount a worker in California won in a lawsuit for a heart attack caused by second-hand smoke.
300 per cent:The increased chance of a heart attack for smokers over non-smokers.

Sources: Health Canada, Canadian Council on Tobacco Control, Canadian Lung Association, Centre for Disease Control, Atlanta, Physicians for a Smoke-free Canada, The Medical Post, U.S. Surgeon General and the World Health Organization.

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