The Burden of Tobacco Use

THE WORKPLACE WELLNESS MAGAZINE THE BURDEN OF TOBACCO USE

Tobacco use remains the leading Each month you can learn cause of death in the United States. more about the articles Indeed, some 450,000 people will WEB in Absolute Advantage. die this year due to tobacco-related infopoint.welcoa.org Simply log on to illnesses. What’s more, 50,000 people LINK WELCOA’s members only die each year from secondhand website to get more in-depth smoke-related diseases. If left unchecked, by the year 2020, coverage of the topics that matter tobacco is projected to kill about 10 million people a year most to you. Find full-length interviews, expert worldwide. This issue of Absolute Advantage is dedicated insight, and links to additional information to addressing tobacco use at the workplace. that will help you do your job better!

THE WELLNESS COUNCILS OF AMERICA

Give others in your company the Advantage. Please route to: q Senior Management q Human Resources q Benefits Department q Fitness Center ABSOLUTE ADVANTAGE WELCOA®

From The Executive Editor

In this issue of Absolute Advantage we’ll address the topic of tobacco use at the workplace. Although often times neglected—largely due to the nation’s new focus on obesity—tobacco use is a critical issue that every employer needs to address.

With healthcare costs approaching 1.8 trillion and healthcare becoming a precious resource, proactive employers are taking bold and aggressive steps to stemming the tide of tobacco use at the workplace.

In this issue, we’ll examine the burden of tobacco use in the United States. Even for the most hardened of David Hunnicutt, PhD skeptics, the statistics are simply staggering.

Having provided an aerial view of the issue, we’ll delve into a series of articles addressing commonly asked questions about cigarettes, cigars, and smokeless tobacco. With healthcare costs To help you in your quest to address tobacco use at the workplace, we’ve provided dozens of easy-to-implement ideas. We’ve also highlighted a fascinating website— approaching 1.8 trillion www.thetruth.com. In addition, we’ll share an interview done with Jeffrey Wigand, a former tobacco industry and healthcare becoming insider. Finally, we’ll examine a case study of Weyco, Inc., a company that has set a policy to fire its smokers.

I hope you enjoy this issue. I’d like to recognize the a precious resource, proactive National Cancer Institute for developing and making available much of the information contained in this issue. employers are taking bold Yours in good health, and aggressive steps to

Dr. David Hunnicutt stemming the tide of tobacco President, Wellness Councils of America use at the workplace.

The Burden Of Tobacco Use THE WORKPLACE WELLNESS MAGAZINE

Organizational Founder, William Kizer, Sr. An estimated 45.8 million adults in the United States smoke

WELCOME cigarettes, even though Absolute Advantage is the interactive workplace wellness magazine that helps large and small employers link health and this single behavior will well-being to business outcomes. Absolute Advantage arms business leaders and wellness practitioners with leading- edge workplace wellness information straight from the field’s most respected business and health experts. result in death or With its online component, Absolute Advantage provides the industry’s most current and accurate information. By logging on to the magazine’s interactive website, you can access a whole new world of health promotion—including disability for half of in-depth interviews with national health promotion experts and insider’s information about industry products. all regular smokers. SUBSCRIPTION INFORMATION For information about subscribing to Absolute Advantage, contact the Wellness Councils of America at (402) 827-3590 or via e-mail at [email protected]. Page 2

Ab•sol•ute Ad•van•tage: When a company can produce more than its competitors—even though they have the same amount of resources—it has an absolute advantage. We believe wellness is that advantage. 4 50 Great Ideas To Help Your Employees Quit Smoking EXECUTIVE EDITOR | David Hunnicutt, PhD If you’re looking for easy-to-implement ideas to help you address smoking at the workplace, you’ll find this article helpful. Dr. Hunnicutt is President of the Wellness Councils of America. As a leader in the field of health promotion, his vision has led to the creation of numerous publications designed 20 Notable & Quotable to link health promotion objectives to business outcomes. These maxims, mantras, and notable quotes about smoking and VICE PRESIDENT OF MARKETING | Galen Moes tobacco use will make you stop and think. With more than 15 years experience in a Berkshire-Hathaway company, Galen joined WELCOA as Vice President of Marketing and is responsible for developing strategic 24 Q&A: Cigar Smoking direction and taking the primary leadership role in marketing all of WELCOA’s products Cigars remain a leisure pursuit for many Americans. However, the and services throughout the US. risks of cigar smoking are very real. | SENIOR EDITOR Mike Perko, PhD 28 Q&A: “Light” Cigarettes Dr. Perko has significant experience in worksite wellness. Currently the Chair of Health Recently, there’s been a lot of discussion and controversy Education at the University of Alabama, Dr. Perko also serves on WELCOA’s Medical surrounding “light” cigarettes. Get the real story. Advisory Board and often speaks on behalf of the Wellness Councils of America. MANAGING EDITOR | Brittanie Leffelman, MS 32 Q&A: Secondhand Smoke Brittanie is the Director of Operations and manages major writing projects at WELCOA. Secondhand smoke will kill 50,000 people in the US. Find out what With a Master’s Degree in Health Promotion, she regularly coordinates national health the health effects of secondhand exposure really are. forums, major grants, and state and local wellness initiatives. DIRECTOR OF MEMBERSHIP | David Steurer, MEd 36 Q&A: Smokeless Tobacco Although smokeless tobacco is commonly overlooked, it remains an As WELCOA’s Director of Membership, David is responsible for recruiting and servicing important issue of any tobacco cessation initiative. member organizations throughout the United States. David’s background has been grounded in worksite wellness for the past 25 years. 40 The Truth Is Found DIRECTOR OF COUNCIL AFFAIRS | Kelly Stobbe, MEd The nationally recognized webiste, thetruth.com is an intriguing and As the Director for Council Affairs, Kelly is responsible for leading WELCOA’s cadre of enlightening place to visit. To discover the truth, read on. locally-affiliated wellness Councils. In this capacity, Kelly coordinates the Well Workplace awards initiative as well as the Well City USA community health project. 44 Moral Treason: A Former DIRECTOR OF DESIGN & TECHNOLOGY | Justin Eggspuehler Tobacco Industry Insider Speaks Out Jeffrey Wigand, the mythical figure that the movie The Insider was A 2001 graphic design graduate from Iowa State University, Justin studied design in Rome, Italy before joining the WELCOA design staff. He is responsible for the layout and design based on, speaks out about what he knows from his days as a of many publications including The Well Workplace newsletter and Absolute Advantage tobacco scientist. magazine. 54 Helping Your Employees Live MULTIMEDIA DESIGNER | Adam Paige Tobacco Free Adam joined WELCOA in early 2005. With corporate experience in design and videography, Check out this step-by-step approach to help your employees kick He brings a wealth of talent to WELCOA’s publication. In the capacity of a multimedia the habit. designer, Adam contributes to the publications of The Well Workplace newsletter and Absolute Advantage magazine. 58 Where There’s Smoke...There’s A New Kind Of Fire Information in this publication is carefully reviewed for accuracy. Questions, comments, or ideas are welcome. Please direct to Dr. David Hunnicutt, Executive Editor, at the address below. Employers are taking aggressive and bold measures to address Information may not be reproduced, copied, cited, or circulated in any printed or electronic form without written permission from the smoking in the workplace. Don’t miss this article. publisher. ©2006 Wellness Councils of America, 9802 Nicholas Street, Suite 315, Omaha, NE 68114; phone (402)827-3590; fax (402) 827-3594; visit our website at www.welcoa.org. All rights reserved. ISSN 1538-0084.

| ABSOLUTE ADVANTAGE ©2006 WELLNESS COUNCILS OF AMERICA | WWW.WELCOA.ORG ABSOLUTE ADVANTAGE WELCOA® n estimated 45.8 million adults Smokeless tobacco, cigars, and pipes in the United States smoke also have deadly consequences, TOBACCO & CANCER cigarettes even though this including lung, larynx, esophageal, Tobacco is one of the strongest single behavior will result in and oral cancers. Low-tar cigarettes cancer-causing agents. Tobacco death or disability for half and other tobacco products are not use is associated with a number of of all regular smokers. Tobacco use is safe alternatives. different cancers, including lung the leading preventable cause of death cancer, as well as with chronic in the United States, resulting in The harmful effects of smoking do lung diseases and cardiovascular approximately 440,000 deaths each not end with the smoker. Babies of diseases. women who smoke during pregnancy year. More than 8.6 million people ➤ Tobacco use remains the in the United States have at least one are more likely to have lower birth leading preventable cause serious illness caused by smoking. If weights, an increased risk of death of death in the United States, current patterns of smoking persist, from sudden infant death syndrome, causing more than 440,000 6.4 million people currently younger and respiratory distress. In addition, deaths each year and resulting than 18 will die prematurely of a secondhand smoke has harmful in an annual cost of more than tobacco-related disease. Paralleling effects on nonsmokers. Each year, $75 billion in direct medical this enormous health toll is the primarily because of exposure to costs. economic burden of tobacco use: secondhand smoke, an estimated ➤ In 2003, 29.8 percent of more than $75 billion per year in 3,000 nonsmoking Americans die of the U.S. population 12 and medical expenditures and another lung cancer, and more than 35,000 older — 70.8 million people $80 billion per year resulting from die of heart disease. — used tobacco at least once lost productivity. in the month prior to being An estimated 150,000–300,000 interviewed in a national Since 1964, 28 Surgeon General’s children younger than 18 months survey. This figure includes 3.6 reports on smoking and health of age have lower respiratory tract million people age 12 to 17. have concluded that tobacco use infections because of exposure to ➤ Approximately 80% of adult is the single most avoidable cause secondhand smoke. smokers started smoking of disease, disability, and death in before the age of 18. Every day, Although smoking rates fell among the United States. Over the past nearly 4,000 young people high school students from 2000 four decades, cigarette smoking under the age of 18 try their has caused an estimated 12 million to 2002, they did not decline first cigarette. deaths, including 4.1 million deaths significantly among middle school ➤ Scientists estimate that from cancer, 5.5 million deaths from students. This lack of progress environmental tobacco smoke cardiovascular diseases, 2.1 million suggests the need for greater use of (ETS), also called “secondhand proven antismoking strategies and deaths from respiratory diseases, smoke,” is responsible for and 94,000 infant deaths related to for new strategies to promote further approximately 3,000 lung mothers smoking during pregnancy. declines in youth smoking. cancer deaths per year among adult nonsmokers in the 442,398 U.S. Deaths Attributable Each Year To Cigarette Smoking* United States. ➤ In the United States, it has ¢ Lung Cancer: 124,813 been estimated that about ¢ Coronary Heart Disease: 81,976 7.8 million people age 12 years and older currently use ¢ Chronic Lung Disease: 82,431 smokeless tobacco. ¢ Other Diagnoses: 104,785 http://www.cancer.gov/cancertopics/ tobacco/statisticssnapshot ¢ Stroke: 17,445 ¢ Other Cancers: 30,948 The information in this article was provided by the National Cancer *Average annual number of deaths, 1995–1999. Institute and is in the public domain. For Source: MMWR 2002;51(14):300–3. more information, visit their website at http://www.cdc.gov/nccdphp/publications/aag/osh.htm www.cancer.gov.

moking cessation could quite possibly be one of the most difficult programs you implement at the workplace, but don’t get burned out Sjust yet—many companies have had great success. Northwestern Memorial Hospital, for example, has addressed worksite smoking and taken a significant step toward ensuring a healthy culture at the workplace. Their smoking policy enforces no smoking both inside and outside the hospital. In addition, they prove their dedication to the policy by offering a smoking cessation class and encouraging employees to quit. Their program includes individual consultations with a smoking cessation specialist, and sessions that are offered on a variety of days, times, and locations on the hospital campus every quarter for employee convenience.

©2006 WELLNESS COUNCILS OF AMERICA | WWW.WELCOA.ORG ABSOLUTE ADVANTAGE | ABSOLUTE ADVANTAGE WELCOA® Be graphic. Hang up posters that contain tough Light their fire. Get senior support by showing messages and vivid, full-color images that inform costs. A worksite smoking cessation program will 1 employees of the harmful effects of using tobacco. 4 generate economic benefits that exceed the program’s Posters should be displayed in high traffic areas, such cost. Previous studies have overestimated the short-term as elevators, bathrooms, near water coolers, etc. The benefit-cost ratio and underestimated the long-term benefit- Government of Canada has passed regulations that require cost ratio of a worksite smoking cessation program.14 cigarette manufacturers to place graphic images and Begin your subscription to information covering 50% of every cigarette package! 11 >>TAKE ACTION! The American Journal of Health Promotion by visiting >>TAKE ACTION! Log on to www.thetruth.com to www.healthpromotionjournal.com. This journal is discover a lot of excellent information that details—in a well-respected publication in health promotion and graphic account—the consequences and hazards of provides tons of useful information regarding behavior tobacco use. This site is guaranteed to stimulate some change and costs and benefits. creative thinking. Assess and progress. Health screenings will allow Get real. In France, the federal government you to assess the risk factors of your smoking imposed public smoking restrictions without 5 population. For example, Highsmith Inc. holds informing the public of why such actions were an annual health screening exam, in which participants 2 12 taken; as a result, compliance has been less than ideal. get results along with a 20-minute counseling session. If To avoid negative feedback or confusion about smoke- they need more help, ongoing support and follow-up by a free workplace policies, hold educational workshops or personal trainer is available. seminars that inform employees about the health risks >>TAKE ACTION! To find out what health screenings that accompany smoking—this will lay the groundwork are most appropriate for your organization, obtain for good adherence to your organization’s regulations and information about periodic health examinations. This legislations. information is available from The American Academy of >>TAKE ACTION! Develop a company-wide Family Physicians and can be accessed online at http:// presentation that highlights the costs and consequences of www.aafp.org/exam.xml. By utilizing this information, using tobacco. Be sure to emphasize real issues like not you’ll know exactly when to screen your employees. being able to walk up a flight of stairs without huffing Don’t be a hypocrite. If you smoke, your and puffing. For great information to help you present employees are going to have a hard time believing your business case, visit http://www.endsmoking. in your company’s campaign against smoking— org/resources/employersguide/pdf/employersguide- 6 and with good reason. Be an example to those in your 2nd-edition.pdf. There you’ll find a great resource titled company, if you smoke, quit now, or don’t lead any Employers’ Smoking Cessation Guide. smoking initiatives at all. No butts about it. Implement a no-smoking >>TAKE ACTION! If you do presently smoke, you policy. A reduction of cigarette consumption in the can share your quitting experience with the rest of the U.S. between 1988 and 1994 can be credited to 3 organization. In fact, we know of one CEO who wanted to smoke-free workplaces—9.72 billion less cigarettes were be a positive role model, so he shared his quitting experience 13 smoked as a result of these policies. Cabell County Board through daily e-mails with the rest of the company. of Education in Huntington, West Virginia not only implemented a no-smoking policy inside their facilities, The more the merrier. Build a team to promote but outside as well. Plain and simple, if it’s company smoking cessation. This team should be made up of policy, it’ll be easier to enforce. 7 smokers, non-smokers, and ex-smokers. With their wide range of views and experiences, they will be able to >>TAKE ACTION! Obtain a copy of Making Your cohesively create plans and initiatives that will generate a Workplace Smokefree: A Decision Maker’s Guide, produced new, smoke-free culture. by the Wellness Councils of America (www.welcoa.org). This useful book provides actual examples of policies and >>TAKE ACTION! We recommend that you immediately the information that should be contained in them. identify and recruit current smokers (who are looking

5 Health screenings will allow you to assess the risk factors of your smoking population.

to quit) and get them on your team ASAP. While it is if they achieve a 35 to 55% quit rate. At Lab Safety, inappropriate for you to lead your company’s wellness 80% of 82 people on the nicotine patch quit. Eighty-five initiative—and at the same time smoke—it is most percent out of 78 people quit in the hypnosis program, and appropriate for you to include current smokers on your after six months, 68% were still not smoking. wellness team. >>TAKE ACTION! For an inside look at smoking Get acquainted. Send out questionnaires or e-mails cessation programs, visit www.smokestoppers.com. This to find out who smokes, who wants to quit, and site will give you an overview of what it takes to quit 8 who doesn’t. Once you have this information you’ll smoking and a curriculum to back it up. In addition, you’ll know which intervention to direct to which population. also find a lot of other helpful information like statistics For example, don’t expect those who don’t want to quit to and personal assessments. stop cold turkey from a single anti-smoking brochure. Help wanted. Many people want to quit >>TAKE ACTION! Check out StayWell and Summex. smoking, in fact, a recent Gallup survey Both of these organizations provide tools to assess employee revealed that one-third of smokers wish they 1015 habits and their willingness to change. StayWell’s web could quit. The truth is, many smokers can’t quit on address is www.staywell.com and you can find Summex their own—they need the help of others. Counseling can at www.summex.com. provide valuable support for recovering smokers. To create your own support group, designate a specific space and Focus on frequency. It’s going to be hard for time for group meetings and publicize these meetings in smokers to quit if a cessation program is only held your wellness and company publications. Be sensitive to 9 once a month. If possible, hold multiple weekly the issue of confidentiality. meetings to continue treatment and discuss progress. You may have to experiment with a variety of strategies >>TAKE ACTION! Check out The Human Resources to find out what is most effective. For example, Lab Institute at www.healthyculture.com. You’ll want to Safety Supply, located in Janesville, Wisconsin took on obtain a copy of the Wellness Mentor Program Facilitator multiple approaches to get their employee population to Package. This information will provide you with the ins quit smoking—and the results were amazing. Corporate and outs of starting and leading a peer support group— smoking cessation programs are considered very successful videos and other helpful information is provided.

©2006 WELLNESS COUNCILS OF AMERICA | WWW.WELCOA.ORG ABSOLUTE ADVANTAGE | ABSOLUTE ADVANTAGE On your mark, get set. Make smoking >>TAKE ACTION! Have employees devise a written plan cessation programs competitive. Employees of how they’ll react to and escape smoking temptations. To 11might feel more compelled to quit if there learn more about the art and science of quitting smoking, is something at stake. One study has shown that visit the American Cancer Society’s website at www.cancer. competitive smoking cessation programs are the most org and type “smoking cessation” in the search bar. effective and offer the best return on investment. The Just what the doctor ordered. Advise programs may be expensive, costing around $100 per employees who smoke to see their health care employee, however, keep in mind that a smoker costs an provider. Brief, personal advice from a health employer hundreds of dollars more every year.13 13 care professional can double or quadruple normal quit 16 >>TAKE ACTION! Try splitting your program into two rates. Evidence also suggests that physician counseling 17 teams. Have members of the opposing teams keep tabs on can increase your chances of success by 50%. each other, to ensure that no one is cheating. The team >>TAKE ACTION! Identify your organization’s health who has been the most successful in keeping their non- care providers and initiate conversations to ensure that smoking status wins—the rewards and incentives are up to physicians are routinely counseling patients on the you and your budget. advantages of quitting smoking. Yes, it’s oftentimes a hard thing to talk about with health care providers—but Sweet seductions. Plain and simple, quitting physician intervention might be the most cost-effective smoking is hard and the road to recovery is approach to quitting smoking that we know of. 12 long. In fact, according to behavior change guru, Dr. James Prochaska, smokers are likely to relapse Close, but no cigar. The consumption of before permanently quitting. With this in mind, it’s all types of cigars in the U.S. increased by essential that smokers begin to think about the people, 14 46.4% between 1993 and 1997. Compared places, and things that may cause them to go back to their to a cigarette, a large cigar emits about 20 times more old behaviors. carbon monoxide. Studies show that cigar smokers have

19 Make sure that “no-smoking” signs are posted around your facility.

| ABSOLUTE ADVANTAGE ©2006 WELLNESS COUNCILS OF AMERICA | WWW.WELCOA.ORG WELCOA® an increased risk of oral, esophageal, laryngeal, and recent study showed that workplace clinic participants had lung cancer—yet, only 8.7% of cigar smokers consider success rates of 21% while self-help groups only had 11% themselves at high-risk for developing cancer.18 success rates.13

>>TAKE ACTION! Make sure that you incorporate >>TAKE ACTION! Identify smoking cessation information about cigars as well as smokeless tobacco in all facilitators in your community. To learn more about of your presentations. More information about these other smoking cessation and health coaching visit wellcoaches. dangerous forms of tobacco is available at The American com at http://www.wellcoaches.com/clients/index. Academy of Family Physicians website at www.aafp.org. cfm?Pageid=mainpage. Here you can learn about contacting coaches in your area. Educate, educate, educate. Although 90% of Americans “know” that smoking is Rx. Pharmaceutical interventions can hazardous, they only know it in a superficial play a large part in an employee’s effort 153 sense. In 1996, The American Council on Science 18 to quit smoking. A study determining the and Health (ACSH) found that American smokers and effectiveness of nicotine patches (in a 70-day nicotine nonsmokers had only the most elementary understanding replacement program) found that the smoking cessation of the extent and magnitude of the health risks associated rate was much more favorable for those who used the with cigarette smoking as compared with other alleged patch—25% compared to 6% for those who did not health risks in the environment. complete the treatment.13 Offutt Air Force Base has found that participants respond well to this type of intervention. >>TAKE ACTION! Conduct your own “Great American Their tobacco cessation program is one of the most Health Quiz.” Incorporate questions about the hazards popular wellness initiatives—they offer nicoderm patches of smoking as well as other types of trivia and interesting and prescription medications with the American Cancer information and distribute the quizzes to your employees. Society’s Fresh Start Program. To obtain information on the statistics of cigarette smoking contact The American Heart Association at >>TAKE ACTION! Collect information on the cost and www.americanheart.org. effectiveness of a variety of different cessation techniques (gum, inhalers, pills) and have this information readily Cover the costs. A study has shown that available to employees. You can also display products and the highest rates of participation in smoking information in prominent places for all employees to view. cessation programs occur when insurance To learn more about smoking cessation drugs you may 16 19 covers the costs of the program. Don’t stick your want to contact Glaxo Smith Kline—www.zyban.com. employees with the bill—if your insurance company won’t pay for all the expenses involved, pick up the tab yourself You expect me to breathe what? Protect and increase your participation rate. Learning kits, kits employees who don’t smoke. The California with phone support, and computerized programs are not 19 Environmental Agency Report estimated cheap, but are sometimes needed for positive results. that each year in the U.S., environmental tobacco smoke (ETS), also known as secondhand smoke, exposure causes >>TAKE ACTION! Identify how much smokers 3,000 deaths due to lung cancer, 35,000 to 62,000 deaths are costing your organization and present this dollars due to ischemic heart disease, and 1,900 to 2,700 deaths and cents info to your senior management. One great due to sudden infant death syndrome.21 resource to quantify the cost of smoking is “Smoking in the Workplace Costs Employers Money”—the report is >>TAKE ACTION! Make sure that “no-smoking” signs available at www.ash.org/papers/h100.htm. are posted around your facility. Also make sure that the employee handbook is updated and inform new employees Work it. Workplace smoking cessation clinics of smoking guidelines. Above all, make sure to enforce can be extremely helpful and convenient. the policies—smokers need to know you mean business, 17 Along with their no-smoking policy—inside and non-smokers deserve to be protected. and outside their entire facility—Miami Valley Hospital also supports employees who are trying to quit by offering Tell the truth. Don’t sugar coat the dangers onsite cessation classes. They’ve come upon the reality your employees are facing. You might not that many smokers need more than just self-help—a 20 be making any best friends by telling your ©2006 WELLNESS COUNCILS OF AMERICA | WWW.WELCOA.ORG ABSOLUTE ADVANTAGE | ABSOLUTE ADVANTAGE WELCOA® employees that they could die a horrible, excruciating The birth of a child is the ultimate teachable moment. death, but this shows that you care about their well-being. They may not be interested in quitting for their own good, In addition to lung cancer and emphysema, cigarette but few parents will be willing to sacrifice their child’s smoking is known to adversely affect nearly every system healthy future for their own pleasure. and function of the human body.2 Have a potluck. Try incentive-based >>TAKE ACTION! Offer games that identify the various smoking cessation programs. Have systems and functions of the body that are affected by 24 participants drop money they would have smoking. For example, a hangman message reading spent on cigarettes into a “smoke bank.” Upon completion “smoking kills” will leave an indelible mark. To get more of the program, allow only those who are still smoke-free information, you may want to visit www.healthedco.com to draw for the money in the pot. and enter the keyword “tobacco” into the search engine. >>TAKE ACTION! Show them the costs. Based on a Hold demos. Visual aids can be very pack a day habit, a smoker will spend nearly $1,587 on effective. Simply presenting a film or showing cigarettes every year. Following this logic, a six-month a picture of a healthy lung compared to the incentive program, involving only five participants would 21 yield a windfall of almost $4,000. picture of a smoker’s lung can be quite powerful. Start campaigning. Create your own no- >>TAKE ACTION! Be sure to include information about smoking ad campaigns within the company— how quickly the human body recovers from habitual 33,000 ex-smokers in California cited smoking. This will help ensure that long-time smokers don’t 25 tobacco-control advertisements as a significant factor in feel defeated by the graphic images and keep on puffin’. their decision to quit.22 The most effective strategies for Check out http://www.cancer.org/docroot/PED/content/ anti-smoking advertising focus on industry manipulation PED_10_13X_Quitting_Smoking.asp for a timeline that and secondhand smoke. One California ad ended with shows the short and long-term benefits of smoking cessation. the line “The Tobacco Industry. They profit. You lose.”— Be on your toes. It’s inevitable. At some showing how manipulative the industry can be in point someone is bound to say, “Bill has their relentless pursuit of profits. Another effective 22 smoked for 40 years and is as healthy as a advertisement showed a child as a victim of secondhand horse.” You need to know how to respond to this comment. smoke, which made people more aware of the effects Be prepared to come back with, “Well, 400,000 people die of their smoking on others. from tobacco related illnesses each year. In fact, it most >>TAKE ACTION! At the end of the campaign, combine likely will be the worst plague the world has ever known.” the ads into a montage that could be broadcast over the >>TAKE ACTION! Make a top ten list of the most company intranet, closed circuit televisions, or any visual popular excuses people give to justify their continued medium available at your organization. Check out the smoking. List counter points below these excuses Visual Culture and Public Health Posters surrounding that refute the “logic.” For a whole host of compelling anti-smoking campaigns. (http://www.nlm.nih.gov/ information to help you build your case, visit the World exhibition/visualculture/antismoking.html) Health Organization’s website at www.who.int. Recruit the quitters. The American Cancer Play the emotional card. Every year, 702 Society offers a free training program for infants die as a result of secondhand smoke. If 26 ex-smokers to be leaders of smoking cessation 23you’ve been unsuccessful getting a smoker to classes. There’s no one more persuasive than a true ex-smoker. quit for their own sake, address the harm they are causing >>TAKE ACTION! After training, these ex-smokers to others by smoking. Secondhand smoke inhaled by could lead the entire smoking cessation program. This children contains more than 3,800 chemical compounds. frees you up to address the organization’s other health Because children have less developed lung tissue, they are risks, while a former smoker, familiar with the challenges more vulnerable to the damages caused by smoking.3 of quitting, serves as a mentor to those still trying to quit. >>TAKE ACTION! Seek out new or expecting parents Check out American Cancer Society’s website for resources and impress upon them the dangers of secondhand smoke. near you—http://www.cancer.org.

31 The American Lung Association offers an online program called “Freedom From Smoking® Online.”

Stop in the name of love. Highlight program. The annual one-day event, sponsored by the smoking cessation in conjunction with American Cancer Society (ACS), is held on the third 27 Valentine’s Day. Encourage employees to quit Thursday of every November. This nationwide event tries smoking for someone they love. Never underestimate the to get smokers to kick the habit for just 24 hours. The idea value of accountability. being, if they can give it up for one day, they might as well give it up for good. >>TAKE ACTION! Encourage employees to make a commitment to their loved ones to stop smoking via >>TAKE ACTION! Contact the ACS by calling 1-800- a Valentine’s Day card. A written commitment often ACS-2345 or visiting their website at http://www.cancer. carries more weight and can be used as a reminder of the org/docroot/PED/ped_10_4.asp. Get started right away commitment. by hosting your own corporate Smokeout.

Clear the air. Offer smokers the chance to Protest. Find out which popular eateries in “clear the air” by writing their thoughts and your community have implemented non- 28 feelings on a graffiti board. Sometimes you 30 smoking policies. Hand out a list of these need to jump-start it with an idea or quote to respond places to employees—this will lessen the temptation or to. This will allow smokers to vent the frustrations that chance to light up when out on the town. Also spread the accompany quitting. These anonymous contributions can word that you encourage employees to only go to smoke- be humorous and insightful. This idea was such a good free establishments—this type of “boycott” could motivate one that a major health care provider in Houston created the places that do allow smoking to implement non- their own “graffiti gallery” to showcase their company’s smoking policies. commitment. >>TAKE ACTION! Have employees submit names of >>TAKE ACTION! Collect the comments and compile favorite non-smoking establishments. Compile these them into a book. This book can be used as a program establishments into a directory to be distributed company- builder down the road and will help other smokers realize wide. Share the directory within your community to they’re not alone in their frustrations. Don’t forget to edit encourage additional business owners to go smoke free. where necessary! Get hooked…online. The Internet can be Mark your calendar. Get involved in the an easy, useful tool to help you implement Great American Smokeout. This would be 31smoking cessation programs. The American 29 a good day to kick off a smoking cessation Lung Association offers an online program called “Freedom 12 | ABSOLUTE ADVANTAGE ©2006 WELLNESS COUNCILS OF AMERICA | WWW.WELCOA.ORG ABSOLUTE ADVANTAGE WELCOA® From Smoking® Online.” Through progressive stages of the >>TAKE ACTION! Get your smoking employees to program, the user will learn important skills such as stress substitute their smoke breaks for online chats with others management/relaxation techniques and long-term strategies trying to quit. Breaking a habit is much easier when you for maintaining a smoke-free lifestyle. Access this program can substitute a healthy habit for an unhealthy one. online at http://www.lungusa.org/site/apps/kb/home/ login.asp?c=dvLUK9O0E&b=38973. Baby talk. It’s estimated that smoking during pregnancy accounts for 20 to 30% >>TAKE ACTION! Work with your IT department of low birth weight babies, up to 14% of to create your own smoking cessation web page. 35 pre-term deliveries, and 10% of all infant deaths. Women Modern technologies like streaming video and instant who smoke, and are expecting, need special and intensive messaging can be powerful tools for helping people treatment—they may know it’s not healthy to smoke, quit—especially if it’s customized and reflects individual but they don’t know how to stop. Provide long-term corporate culture. interventions and counseling for pregnant smokers to help Say what? Does anyone really know what’s ensure that they are smoke-free during and after their in a cigarette? Phillip Morris boasts their pregnancy. Unfortunately, children can still suffer from 32 “typical” cigarettes contain at least 90% negative consequences due to smoking even after they tobacco in the “filler” portion. So, what’s in the remainder? are born—between 200,000 and one million asthmatic Well, a “typical” Cambridge 100’s filter hard pack includes children have their condition worsened by exposure to water, sugars, propylene glycol, glycerol, diammonium secondhand smoke.25 phosphate, cocoa, and cocoa products, ammonium hydroxide, natural and artificial flavor.23 Yummy! Let >>TAKE ACTION! Provide programming efforts aimed employees know what they are using to pollute their at reducing and managing the stress of your employees, bodies—this may cause them to think twice about smoking. especially those who are expecting. The more support you >>TAKE ACTION! As the cliché goes, “A picture is can offer, the more success you are likely to see. worth a thousand words.” Providing an insightful visual Keep your door open. Most relapses occur of what is being placed in a smoker’s body can be a early in the quitting process, although some powerful tool in convincing smokers that their habit is as “natural” as it may seem. (http://www.thetruth.com/) relapses occur months or years after the 3626 quit date. Provide brief relapse prevention treatment Show them the money. Smoking is for recent quitters. This treatment can be delivered by expensive. Direct smokers to websites such scheduled clinic visits, telephone calls, support groups, etc. 33 as HealthStatus.com. Smokers have the opportunity to see what smoking is costing them financially. >>TAKE ACTION! Read up on Prochaska’s stages of For example, a person smoking 19 cigarettes a day for five change to better identify those susceptible to relapse and years has spent, on average, $7,541.81.24 Help smokers to brush up on keeping quitters in the maintenance stage. discover their financial waste at http://www.healthstatus. Dr. Prochaska’s book titled Changing For Good is available com/calculate/smc. at www.amazon.com. >>TAKE ACTION! Create you own monthly publication The secret of my success. Find employees or website showing off a number of items smokers would who have already quit, and who have stuck be able to purchase with the money spent on cigarettes. If with it for at least six months. Let these you were able to choose between 142 rounds of golf or five 37 years worth of cigarettes, what would you choose? people speak at company meetings or seminars to tell their stories—what made them quit, and what has helped them Get technical. Create an e-mail stay away from cigarettes. correspondence or chat room for those who 34 are quitting, so they can express how they’re >>TAKE ACTION! Create a campaign titled “Quitters doing/feeling. E-mail is a quick and convenient method of Always Win.” Encourage “quitters” to become team communication. If smokers can talk about their troubles leaders for company recreation activities. Be sure to choose with others who are going through the same thing, they this role model carefully—charisma can be the difference might feel better about quitting. between someone who helps and someone who annoys.

43 A Framingham Heart Study showed that two years after light smokers quit, their risk for heart attack decreased by 20%. Heavy smokers’ risk was reduced by 60% after they quit.

14 | ABSOLUTE ADVANTAGE ©2006 WELLNESS COUNCILS OF AMERICA | WWW.WELCOA.ORG ABSOLUTE ADVANTAGE WELCOA® Take it to da’ house. Let parents know that the individual’s stage of change. PacificCare Health it’s never too early to talk to their children Systems Inc. provides a StopSmoking Program that is about smoking—in fact, many adults self-paced and tailored to meet the specific needs of each 38 27 who smoke started as children. Provide educational participant—adjusting to their level of readiness to quit. information for employees to bring home and share with The program involves a toll-free number, behavior change their kids. Also, parents and kids might want to check coaching via telephone, written materials, video, and out the website http://www.healthfinder.gov/ and type audiotapes—available in both English and Spanish.30 “smoking” or “tobacco” in the search engine for more information. >>TAKE ACTION! Check out HealthMedia Inc.’s website at www.healthmedia.com. This innovative >>TAKE ACTION! Remember, kids who smoke will company has developed online, tailored, smoking cessation become adults who smoke—adults who will one day enter programs that meet every individual where they’re at and the workforce. Sponsor parent-child activities that allow encourages positive lifestyle changes. you to disseminate anti-smoking information that is age appropriate. Also, it’s important that your organization Push the envelope. Offer rewards on health get behind tobacco control policies that keep kids away care plans to non-smoking employees. from cigarettes. 42 Although somewhat controversial it’s been going on for years. In fact, as early as 1987, Colorado began Get them puffing. Promote physical activity, offering a discount of six dollars a month to nonsmoking not dieting, with smoking cessation. Many employees enrolled in its health plan. In 1988, the Kansas 39 smokers gain weight when they quit. A health care governing body proposed that smokers be common reaction to stop weight gain is dieting. But required to contribute ten dollars a month more than restrictions on food and quitting smoking at the same time nonsmokers toward health insurance.13 The bottom line is could spell relapse. Instead, promote exercise to shed and that smoking causes more deaths in the U.S. than any other maintain a healthy weight. This will help those quitting to health behavior bar none—it’s time to push the envelope. keep busy, as well as help relieve stress. >>TAKE ACTION! There are a number of things you >>TAKE ACTION! Once employees feel the benefits of can do involving cash programs—whether they involve kicking the habit, they may become inspired to further saving money or winning it, money can be a great improve their health by exercising regularly. For more motivator for any employee. information about the benefits of physical activity check out wellness guru Ken Cooper’s aerobic center at www. Better late than never. Although smoking cooperaerobics.com. produces an irreversible increase in risk 43 for some diseases, quitting smoking brings Get involved. Take part in your substantial health benefits at any age. Communicate to community’s effort to stop illegal tobacco your employees that even if they’ve smoked half of their 40 use. It might seem like an unworthy effort life, stopping now will have a positive impact on their considering that those under 18 probably can’t even work health. A Framingham Heart Study showed that two at your company, but think about this: young people who years after light smokers quit, their risk for heart attack don’t start using tobacco by age 18 will most likely never decreased by 20%. Heavy smokers’ risk was reduced by start.28 Make sure local convenient and grocery stores are 60% after they quit.3 involved with “We Card”—a program that trains retailers and employees from selling tobacco to minors. >>TAKE ACTION! Research favorite retirement activities and produce a document replete with vacation home >>TAKE ACTION! Check out the “We Card” program photos. Remind smokers that it won’t be long before they at www.wecard.org. Also, look into the possibilities are relaxing in the sun—if they aren’t already six feet under. of corporate sponsorship of youth anti-smoking efforts through partnership with other businesses and Out with the old… Consider offering organizations in the community. alternative means to employees for quitting 44 smoking. Acupuncture, yoga, or hypnosis, Right tools, right time. The key to for example have been used as a treatment for smoking effective smoking cessation programs is cessation. It might not work for everyone, but for some it 41 using appropriate interventions that fit might be worth a try. ©2006 WELLNESS COUNCILS OF AMERICA | WWW.WELCOA.ORG ABSOLUTE ADVANTAGE | 15 ABSOLUTE ADVANTAGE WELCOA® >>TAKE ACTION! Check out Yoga International’s Follow up. After the treatment or program website at http://www.yimag.org. A more comprehensive is over, make sure to keep up-to-date, and source is the National Center for Complementary and 46 follow up on progress. Also be sure to provide Alternative Medicine, http://nccam.nih.gov, this site employees with information and activities to keep them offers information on various types of alternative healing. from smoking. You may want to consider incorporating other wellness initiatives into the smoking cessation Spread the word. Do the parents at your programs—stress management courses or fitness classes are company know that the average age at which two good examples. These additional interventions may 45 smokers start is 12? Do they know that the help them deal with the pressure of wanting to smoke. average age at which kids become regular smokers is 14 and a half?31 Inform employees of the dangers that youth >>TAKE ACTION! Make the commitment to visit the face when confronted with the opportunity to smoke. employee who is attempting to quit smoking, everyday for Stress the importance of talking with their children about a specified amount of time. These visits will allow you to smoking—a choice to start smoking now may become a encourage them in their efforts to quit, as well as direct habit they can’t break later in life. them to new and relevant information regarding smoking cessation. >>TAKE ACTION! Encourage parents to match the money their children save by not purchasing cigarettes. If A bad blend. Inform smokers of the a the child would have spent $10 per week, starting at age consequences involved with combining 12 and the parents match that figure, when the child is 47 smoking and drinking alcohol. When the 16 there would be enough money in the pot to purchase a two are used together, the adverse health effects are decent used car. intensified. Smokers who regularly consume alcohol have a greater chance of developing esophageal cancer than those who do just one or the other.3

>>TAKE ACTION! You may want to inform them of the danger of this combination during a presentation outlining the dangers of drinking and driving. “Cross-selling” allows you to get the message out more than once to more than one group.

Baby steps. 48 Provide ideas on how to cut back for those who can’t quit cold turkey. For those who want to gradually quit, provide ideas and tips in break rooms, fitness centers, e-mails, etc. For example, “keep postponing that first cigarette of the day for a longer and longer time.” Or “Cut back by one cigarette each day until you hit zero.”

“Problems with self-esteem” “Has menial boring job” “Emotionally insecure” “Passive-aggressive” “Probably leads fairly dull existence” “Grooming not a strong priority” “Lacks inner resources” “Group conformist” “Non-thinking” “Not into ideas” “Insecure followers”

These are all terms taken from Big Tobacco’s files that have been used to describe different groups of potential customers for their deadly, addictive products. —Source: http://www.thetruth.com

When are people going to “ realize that breathing in smoke from anything that burns is not a good idea? Duane Alan Hahn ”

18 | ABSOLUTE ADVANTAGE ©2006 WELLNESS COUNCILS OF AMERICA | WWW.WELCOA.ORG ABSOLUTE ADVANTAGE WELCOA® >>TAKE ACTION! Perhaps one of the best ways to quit 7. U.S. Food and Drug Administration. Statement on Nicotine-Containing Cigarettes by David A. Kessler, M.D. Commissioner of Food and Drugs, House Subcommittee on smoking is to use the “buddy system.” Offer to match one Health and the Environment, March 25, 1994. www.fda.gov/bbs/topics/SPEECH/ SPE00052.htm. smoker with another and encourage them to support each 8. The Wellness Councils of America. Healthy, Wealthy & Wise: Fundamentals of other through the tough times. This is another great time Workplace Health Promotion. P.24. 1995. to incorporate competitions. 9. National Cancer Institute. Smoking: Facts and Tips for Quitting. http://cancerweb.ncl. ac.uk/cancernet/400111.html. 10. Action on Smoking and Health. WHO Report: Smoke Endangers 1/2 World’s Kids. Risky business. Although smoking puts http://www.no-smoking.org/june99/06-16-99-6.html. everyone at risk, it’s especially harmful for 11. Brundtland, G.H., M.D., M.P.H. Achieving Worldwide Tobacco Control. The Journal certain individuals. Women who smoke are of the American Medical Association. Vol. 284, No. 6, 2000, pp. 750-751. 49 12. Davis, R., M.D. Exposure to Environmental Tobacco Smoke. The Journal of the two to six times more likely to suffer from a heart attack American Medical Association. Vol.280, No.22, 1998. 32 than nonsmokers. And for adults 60 and older, smoking 13. University of Michigan Health Management Research Center. Cost Benefit Analysis is a major risk factor for six of the top 14 causes of death.33 and Report 2001. 14. The Robert Wood Johnson Foundation. Worksite Smoking Cessation Programs: Health, Make sure you target these groups—inform them of the Economic, and Demographic Implications-A Computer Simulation. http://www.rwjf. increased risks involved with smoking. Try sending an org/index.jsp. 15. Heart Information Network. Desire to Quit on Increase Among Smokers. e-mail to these individuals to raise their awareness. http://www.heartinfo.org/. 16. Mitka, M. Surgeon General’s Newest Report of Tobacco. The Journal of the American >>TAKE ACTION! Perhaps an effective e-mail message Medical Association. Vol 284, No. 11, 2000. to these most at-risk groups could incorporate humor and 17. American Psychiatric Association Public Information. Treatment Works…When You Choose to Stop Smoking. http://www.psych.org/. logic. Try taking the approach of, “You wouldn’t do (insert 18. Baker, F., et al. Health Risks Associated with Cigar Smoking. The Journal of the activity), so why are you smoking?” American Medical Association. Vol 284, No. 6, 2000. 19. Curry, S.J., Ph.D., et al. Use and Cost Effectiveness of Smoking-Cessation Services Movin’ on up. Evaluating such areas as under Four Insurance Plans in a Health Maintenance Organization. The New England Journal of Medicine. Vol 339, No. 10, 1998, pp. 673-679. participation, quit rates, and return-on- 20. CDC. Tobacco Advertising and Promotion. http://www.cdc.gov/tobacco/sgr/sgr_2000/ investment will allow you to see what factsheets/factsheet_advertising.htm. 50 21. Davis, R., M.D. Exposure to Environmental Tobacco Smoke. The Journal of the works and what doesn’t, as well as make any necessary American Medical Association. Vol. 280, No. 22, 1998. adjustments. Carefully examining and analyzing your 22. Goldman, L., M.P.P., Glantz, S., Ph.D. Evaluation of Anitsmoking Advertising program will allow you to take your program to the next Campaigns. The Journal of the American Medication Association. Vol 279, No. 10, 1998. 23. What’s In A Cigarette? www.thetruth.com. http://www.thetruth.com/index. level. It might seem tough or too scientific, but you can cfm?Found=Truth. easily conduct evaluations through surveys, questionnaires, 24. Cost of Smoking Cigarettes Calculator. http://www.healthstatus.com/calculate/smc. or informal meetings. 25. American Lung Association. Asthma and Children Fact Sheet. http://www.lungusa. org/site/pp.asp?c=dvLUK9O0E&b=44352. >>TAKE ACTION! Distribute surveys to program 26. Tobacco Use and Dependence Clinical Practice Guideline Update Panel and Staff. A Clinical Practice Guideline for Treating Tobacco Use and Dependence. The Journal of participants (those who are successful and those who aren’t) the American Medical Association. Vol.283, No.24, 2000. to help you evaluate how successful your efforts were. 27. Centers for Disease Control and Prevention. Facts About Access to Tobacco by Minors. http://www.cdc.gov/tobacco/sgr/sgr_2000/factsheets/factsheet_minor.htm. Remember, you won’t learn anything from these surveys if 28. Centers for Disease Control and Prevention. Coaches—You Can Influence Youth. you didn’t have a program objective to begin with. Also, ask http://www.cdc.gov/tobacco/educational_materials/yuthfax1.htm. survey participants to be brutally honest. There is no room 29. DiFranza, J., M.D., Librett, J., M.P.H. State and Federal Revenues From Tobacco Consumed by Minors. American Journal of Public Health. http://www.apha.org/ to soft-soap anything when it comes to evaluation. journal/abstracts/abstdifr.htm. 30. Krejci, R. Stop Smoking Program. American Journal of Health Promotion, Art and Science of Health Promotion Conference. Vol. 13 No. 6, 1999, pp. 376-383. REFERENCES 31. Business & Health Special Report. What Cigarettes do to American Business. August 1997. 1. Krantz, L. America by the Numbers. Facts and Figures from the Weighty to the 32. National Heart, Lung, and Blood Institute. Facts About Heart Disease and Women: Way-Out. Houghton Mifflin Company. 1993. Kicking the Smoking Habit. http://www.nhlbi.nih.gov/. 2. American Cancer Society. Cancer Facts and Figures 2005. http://www.cancer.org/ 33. National Heart, Lung, and Blood Institute. Check Your Smoking I.Q. docroot/stt/stt_0.asp. http://www.nhlbi.nih.gov/. 3. American Council on Science and Health. Cigarettes, What the Warning Label Doesn’t Tell You. American Council of Science and Health. 1995. All information ©Wellness Councils of America (WELCOA) 2006. 4. Centers for Disease Control and Prevention. Targeting Tobacco Use: The Nation’s WELCOA provides worksite wellness products, services, and information Leading Cause of Death. http://www.cdc.gov/nccdphp/publications/aag/osh.htm. to thousands of organizations nationwide. For more information visit 5. Lewis, L., C.C.N. 52 Ways to Live a Long and Healthy Life. MJF Books. 1993. www.welcoa.org. Suggested Citation: 50 Great Ideas For Quitting Smoking. (2006). WELCOA’s 6. Fairclough, G. Philip Morris Notes Cigarettes’ Benefits for Nation’s Finances. Absolute Advantage Magazine, 5(2), 4-19. The Wall Street Journal. July 16, 2001.

©2006 WELLNESS COUNCILS OF AMERICA | WWW.WELCOA.ORG ABSOLUTE ADVANTAGE | 21 ABSOLUTE ADVANTAGE hen it comes to smoking, notable quotes abound. The quotes below have been researched by staff at The Wellness Councils of America. We encourage you to replicate these quotes W in publications and information that you develop. As with all information, statistics change rapidly. Be sure to check the continued accuracy of some of this information as it may change.

“Scientists around the world “Children have never been A number of top tobacco Statistically, if there are 100 agreed that there is no safe very good at listening to industry officials have people in your company level of exposure to second- or department…8 hand smoke.”10 their elders, but they have stated that they do not believe that tobacco is 1 uses cocaine —Action on Smoking and Health never failed to imitate addictive. They may tell “The makers of Camels are them.” 50 feel they’re under naturally proud of the fact you that smokers smoke moderate stress —James Baldwin that, out of 113,597 doctors for “pleasure,” not to 10 are heavy drinkers who were asked recently satisfy a nicotine craving.7 to name the cigarette they An estimated 45.8 30 smoke preferred to smoke, more million adults in the —Food and Drug Administration 60 sit all day to do their doctors named Camel than any other brand.”1 U.S. smoke cigarettes work “Cigarettes are the only —Life Magazine ad, July 8th, 1946 as even though this single 27 have cardiovascular reported in America By the Numbers behavior will result in available consumer product disease “A person who smokes one death or disability for that is hazardous to health 10 have high blood pack of cigarettes per day will 3 4 when used as intended.” pressure inhale approximately one- half of all regular uses. half cup of tar annually.”5 —The American Council on Science 5 have diagnosed —Centers for Disease —52 Ways to Live a Long and Healthy Life and Health, Cigarettes: What the diabetes Control and Prevention Warning Label Doesn’t Tell You. “If you took 1,000 young 5 have undiagnosed adult smokers, one will be diabetes murdered, 6 will die on the “I phoned my dad to Smoking caused 25 or more have high roads, but 500 will die from tell him I had stopped approximately $157.7 tobacco.” smoking. He called me a blood cholesterol —Richard Peto, Professor of Medical quitter.” billion in annual 35 are overweight by Statistics and Epidemiology, University of Oxford health-related economic 20% or more —Steven Pearl 2 According to Philip Morris costs... 50 don’t wear their safety belts regularly cigarette company, cigarette 70% of young people ages consumption in the Czech —American Cancer Society 7 use marijuana Republic has “positive 12 to 18 who smoke say effects” on national finances that they believe that they in part because smokers’ are already dependent on One California anti- early deaths help offset cigarettes.7 medical expenses.6 smoking ad, “Nicotine —The Wall Street Journal —Food and Drug Administration Soundbites,” presents Seventeen million Americans real industry executives try to quit smoking each year. A recent review of the But more than 15 million costs of treating smoking- denying that nicotine individuals are unable to attributable diseases in exercise that choice because is addictive before the US showed that they they cannot break their Congress.12 addiction to cigarettes. The range from 6 to 8 percent choice that they are making at of health expenditures.2 —Journal of the American a young age quickly becomes little or no choice at all and —American Cancer Society Medical Association will be very difficult to undo for the rest of their lives.7 —Food and Drug Administration “Just what the doctor ordered.” —Ad, L&M cigarettes, 1956

“Act as if what you do makes a difference. It does.” —William James

Neither the tobacco industry nor the warning label has ever warned consumers that smoking is exceptionally “To quit smoking is easy—I myself addictive or has pointed out the minimum amount of have done it many times.” smoking that poses health hazards.3 —The American Council on Science and Health, —Mark Twain Cigarettes: What the Warning Label Doesn’t Tell You

“I think we overuse the More than one-third of word ‘addictive.’ I think smokers reach for their smoking can be a habit.” first cigarette within 10 minutes of awakening; —Brennan Dawson, Tobacco “Smoking kills, and if you’re killed, nearly two-thirds smoke Institute (USA), 1991 with the first half hour.7 you’ve lost a very important part of If all women quit smoking your life!” —Food and Drug Administration during pregnancy, about 4,000 new babies would not —Anti-smoking spokesperson In 1998 tobacco die every year.9 Brooke Shields companies spent —National Cancer Institute nearly $7 billion — or REFERENCES Seventeen million try to quit more than $18 million each year, but fewer than 1. Krantz, L. America by the Numbers. Facts and Figures from the Weighty to the a day — to advertise Way-Out. Houghton Mifflin Company. 1993. one out of ten succeed. For 2. American Cancer Society. Great American Smokeout: Creating A Smoke-Free every smoker who quits, and promote Workplace. http://www.cancer.org. nine try and fail.7 11 3. American Council on Science and Health. Cigarettes, What the Warning Label cigarettes. Doesn’t Tell You. American Council of Science and Health. 1995. —Food and Drug Administration 4. Centers for Disease Control and Prevention. Targeting Tobacco Use: The Nation’s Leading —Centers for Disease Cause of Death. http://www.cdc.gov/nccdphp/publications/aag/osh.htm. 5. Lewis, L., C.C.N. 52 Ways to Live a Long and Healthy Life. MJF Books. 1993. An estimated 3.76 million Control and Prevention daily smokers aged 12 6. Fairclough, G. Philip Morris Notes Cigarettes’ Benefits for Nation’s Finances. The Wall Street Journal. July 16, 2001. through 17 years consumed After surgery for lung 7. U.S. Food and Drug Administration. Statement on Nicotine-Containing Cigarettes an estimated 924 million by David A. Kessler, M.D. Commissioner of Food and Drugs, House Subcommittee packs of cigarettes per year.13 cancer, almost half of on Health and the Environment, March 25, 1994. www.fda.gov/bbs/topics/ SPEECH/SPE00052.htm. smokers resume smoking. —American Journal of Public Health 8. The Wellness Councils of America. Healthy, Wealthy & Wise: Fundamentals of Workplace Health Promotion. P.24. 1995. 3,000 children under Among smokers who 9. National Cancer Institute. Smoking: Facts and Tips for Quitting. suffer a heart attack, http://cancerweb.ncl.ac.uk/cancernet/400111.html. the age of 18 take up 10. Action on Smoking and Health. WHO Report: Smoke Endangers 1/2 World’s Kids. 38% resume smoking http://www.no-smoking.org/june99/06-16-99-6.html. 3 smoking every day. while they are still in the 11. CDC. Tobacco Advertising and Promotion. http://www.cdc.gov/tobacco/sgr/ sgr_2000/factsheets/factsheet_advertising.htm. 7 —The American Council on Science and hospital. 12. Goldman, L., M.P.P., Glantz, S., Ph.D. Evaluation of Anitsmoking Advertising Health, Cigarettes: What the Warning Campaigns. The Journal of the American Medication Association. Vol 279, No. 10, Label Doesn’t Tell You. —Food and Drug Administration 1998. 13. DiFranza, J., M.D., Librett, J., M.P.H. State and Federal Revenues From Tobacco Consumed by Minors. American Journal of Public Health. www.apha.org/journal/ “The only thing that bothers me is if I’m in abstracts/abstdifr.htm. a restaurant and I’m eating and someone All information ©Wellness Councils of America (WELCOA) 2006. says, ‘Hey, mind if I smoke?’ WELCOA provides worksite wellness products, services, and information to thousands of organizations nationwide. For more information visit www. I always say, ‘No. Mind if I flatulate?’ ” welcoa.org. Suggested Citation: Notable & Quotable. (2006). WELCOA’s Absolute Advantage —Common line used by stand-up comedians Magazine, 5(2), 20-23.

24 | ABSOLUTE ADVANTAGE ©2006 WELLNESS COUNCILS OF AMERICA | WWW.WELCOA.ORG ABSOLUTE ADVANTAGE WELCOA® What are the health in size and contain less than 1 gram of tobacco each. Cigars, on the other hand, can vary in size and shape and risks associated with can measure more than 7 inches in length. Large cigars cigar smoking? typically contain between 5 and 17 grams of tobacco. It is not unusual for some premium cigars to contain the Scientific evidence has shown that cancers of the oral tobacco equivalent of an entire pack of cigarettes. U.S. cavity (lip, tongue, mouth, and throat), larynx, lung, and cigarettes are made from different blends of tobaccos, esophagus are associated with cigar smoking. Furthermore, whereas most cigars are composed primarily of a single evidence strongly suggests a link between cigar smoking type of tobacco (air-cured or dried burley tobacco). Large and cancer of the pancreas. In addition, daily cigar cigars can take between 1 and 2 hours to smoke, whereas smokers, particularly those who inhale, are at increased most cigarettes on the U.S. market take less than 10 risk for developing heart and lung disease. minutes to smoke. Like cigarette smoking, the risks from cigar smoking increase with increased exposure. For example, compared How are the health risks with someone who has never smoked, smoking only one to associated with cigar two cigars per day doubles the risk for oral and esophageal cancers. Smoking three to four cigars daily can increase smoking different from the risk of oral cancers to more than eight times the risk those associated with smoking for a nonsmoker, while the chance of esophageal cancer is increased to four times the risk for someone who has never cigarettes? smoked. Both cigar and cigarette smokers have similar Health risks associated with both cigars and cigarettes levels of risk for oral, throat, and esophageal cancers. are strongly linked to the degree of smoke exposure. The health risks associated with occasional cigar smoking Since smoke from cigars and cigarettes are composed of (less than daily) are not known. About three-quarters of many of the same toxic and carcinogenic (cancer causing) cigar smokers are occasional smokers. compounds, the differences in health risks appear to be related to differences in daily use and level of inhalation. What is the effect Most cigarette smokers smoke every day and inhale. In of inhalation on contrast, as many as three-quarters of cigar smokers smoke disease risk? only occasionally, and the majority do not inhale. One of the major differences between cigar and cigarette All cigar and cigarette smokers, whether or not they smoking is the degree of inhalation. Almost all cigarette inhale, directly expose the lips, mouth, tongue, throat, smokers report inhaling while the majority of cigar and larynx to smoke and its carcinogens. Holding an smokers do not because cigar smoke is generally more unlit cigar between the lips also exposes these areas to irritating. However, cigar smokers who have a history of carcinogens. In addition, when saliva containing smoke cigarette smoking are more likely to inhale cigar smoke. constituents is swallowed, the esophagus is exposed to Cigar smokers experience higher rates of lung cancer, carcinogens. These exposures probably account for the fact coronary heart disease, and chronic obstructive lung that oral and esophageal cancer risks are similar among disease than nonsmokers, but not as high as the rates for cigarette smokers. These lower rates for cigar smokers are cigar smokers and cigarette smokers. probably related to reduced inhalation. Cancer of the larynx occurs at lower rates among cigar smokers who do not inhale than among cigarette smokers. How are cigars Lung cancer risk among daily cigar smokers who do not and cigarettes inhale is double that of nonsmokers, but significantly less different? than the risk for cigarette smokers. However, the lung cancer risk from moderately inhaling smoke from five Cigars and cigarettes differ in both size and the type cigars a day is comparable to the risk from smoking up to of tobacco used. Cigarettes are generally more uniform one pack of cigarettes a day.

Blood pressure, “ pulse rate, and breathing patterns start returning to normal soon after quitting cigar smoking.” What are the hazards cigarettes are made. Cigars go through a long aging and fermentation process. During the fermentation process, for nonsmokers exposed high concentrations of carcinogenic compounds are to cigar smoke? produced. These compounds are released when a cigar is smoked. Also, cigar wrappers are less porous than cigarette Environmental tobacco smoke (ETS), also known as wrappers. The nonporous cigar wrapper makes the burning secondhand or passive smoke, is the smoke released from of cigar tobacco less complete than cigarette tobacco. As a a lit cigar or cigarette. The ETS from cigars and cigarettes result, compared with cigarette smoke, the concentrations contains many of the same toxins and irritants (such of toxins and irritants are higher in cigar smoke. In as carbon monoxide, nicotine, hydrogen cyanide, and addition, the larger size of most cigars (more tobacco) ammonia), as well as a number of known carcinogens and longer smoking time produces higher exposures to (such as benzene, nitrosamines, vinyl chloride, arsenic, nonsmokers of many toxic compounds (including carbon and hydrocarbons). Because cigars contain greater monoxide, hydrocarbons, ammonia, cadmium, and other amounts of tobacco than cigarettes, they produce greater substances) than a cigarette. For example, measurements amounts of ETS. of the carbon monoxide (CO) concentration at a cigar There are, however, some differences between cigar and party and a cigar banquet in a restaurant showed cigarette smoke due to the different ways cigars and indoor CO levels comparable to those measured on a

26 | ABSOLUTE ADVANTAGE ©2006 WELLNESS COUNCILS OF AMERICA | WWW.WELCOA.ORG ABSOLUTE ADVANTAGE WELCOA® crowded California freeway. Such exposures could place someone quits, an improvement in health is seen almost nonsmoking workers attending such events at significantly immediately. For example, blood pressure, pulse rate, and increased risk for cancer as well as heart and lung diseases. breathing patterns start returning to normal soon after quitting. People who quit will also see an improvement Are in their overall quality of life. People who decide to quit cigars have many options available to them. Some people choose to quit all at once. Other options gaining popularity in addictive? this country are nicotine replacement products, such as patches, gum, and nasal sprays. If considering quitting, ask Nicotine is the agent in tobacco that is capable of causing your doctor to recommend a plan that could best suit you addiction or dependence. Cigarettes have an average total and your lifestyle. nicotine content of about 8.4 milligrams, while many popular brands of cigars will contain between 100 and 200 milligrams, or as many as 444 milligrams of nicotine. What are the As with cigarette smoking, when cigar smokers inhale, current trends nicotine is absorbed rapidly. However, because of in cigar smoking? the composition of cigar smoke and the tendency of cigar smokers not to inhale, the nicotine is absorbed Although cigar smoking occurs primarily among predominantly through the lining of the mouth rather males between the ages of 35 and 64 who have higher than in the lung. It is important to note that nicotine educational backgrounds and incomes, recent studies absorbed through the lining of the mouth is capable of suggest new trends. Most new cigar users today are forming a powerful addiction, as demonstrated by the teenagers and young adult males (ages 18 to 24) who large number of people addicted to smokeless tobacco. smoke occasionally (less than daily). According to two Both inhaled and noninhaled nicotine can be addictive. large statewide studies conducted among California The infrequent use by the average cigar smoker, low adults in 1990 and 1996, cigar use has increased nearly number of cigars smoked per day, and lower rates of five times among women and appears to be increasing inhalation compared with cigarette smokers have led among adolescent females as well. Furthermore, a some to suggest that cigar smokers may be less likely to be number of studies have reported high rates of use among dependent than cigarette smokers. not only teens but preteens. Cigar use among older males Addiction studies of cigarettes and spit tobacco show (age 65 and older), however, has continued to decline that addiction to nicotine occurs almost exclusively since 1992. during adolescence and young adulthood when young people begin using these tobacco products. Also, several How are current trends studies raise the concern that use of cigars may predispose individuals to the use of cigarettes. A recent survey showed in cigar smoking that the relapse rate of former cigarette smokers who different from past smoked cigars was twice as great as the relapse rate of former cigarette smokers who did not smoke cigars. The decades? study also observed that cigar smokers were more than Total cigar consumption declined by about 66 percent twice as likely to take up cigarette smoking for the first from 1973 until 1993. Cigar use has increased more than time than people who never smoked cigars. 50 percent since 1993. The increase in cigar use in the early 1990s coincided with an increase in promotional What are media activities for cigars. the benefits

of quitting? The information in this article was provided by the National Cancer Institute and is in the public domain. For more information, visit their There are many health benefits to quitting cigar smoking. website at www.cancer.gov. The likelihood of developing cancer decreases. Also, when

28 | ABSOLUTE ADVANTAGE ©2006 WELLNESS COUNCILS OF AMERICA | WWW.WELCOA.ORG ABSOLUTE ADVANTAGE WELCOA® any smokers choose “low-tar,” “mild,” burned during the machine test. The result is that the “light,” or “ultra-light” cigarettes machine measures less tar and nicotine levels than is because they think that these available to the smoker. cigarettes may be less harmful to their ➤ health than “regular” or “full-flavor” Because smokers, unlike machines, crave nicotine, cigarettes.M Although smoke from light cigarettes may they may inhale more deeply; take larger, more rapid, feel smoother and lighter on the throat and chest, light or more frequent puffs; or smoke a few extra cigarettes cigarettes are not healthier than regular cigarettes. The each day to get enough nicotine to satisfy their truth is that light cigarettes do not reduce the health risks craving. This is called “compensating,” and it means of smoking. The only way to reduce a smoker’s risk, and that smokers end up inhaling more tar, nicotine, and the risk to others, is to stop smoking completely. other harmful chemicals than the machine-based numbers suggest. What about the lower tar What is the scientific and nicotine numbers evidence about the health on light and ultra-light effects of light cigarettes? cigarette packs and in ads for ➤ The Federal Government’s National Cancer Institute these products? (NCI) has concluded that light cigarettes provide no ➤ These numbers come from smoking machines, which benefit to smokers’ health. “smoke” every brand of cigarettes exactly the same way. ➤ According to the NCI monograph Risks Associated ➤ These numbers do not really tell how much tar and with Smoking Cigarettes with Low Machine- nicotine a particular smoker may get because people Measured Yields of Tar and Nicotine, people who do not smoke cigarettes the same way the machines switch to light cigarettes from regular cigarettes do. And no two people smoke the same way. are likely to inhale the same amount of hazardous chemicals, and they remain at high risk for developing How do light cigarettes smoking-related cancers and other diseases. trick the smoking ➤ Researchers also found that the strategies used by the tobacco industry to advertise and promote machines? light cigarettes are intended to reassure smokers, to discourage them from quitting, and to lead consumers ➤ Tobacco companies designed light cigarettes with to perceive filtered and light cigarettes as safer tiny pinholes on the filters. These “filter vents” dilute alternatives to regular cigarettes. cigarette smoke with air when light cigarettes are “puffed” on by smoking machines, causing the machines ➤ There is also no evidence that switching to light or to measure artificially low tar and nicotine levels. ultra-light cigarettes actually helps smokers quit. ➤ Many smokers do not know that their cigarette filters have vent holes. The filter vents are uncovered when Have the tobacco cigarettes are smoked on smoking machines. However, companies conducted filter vents are placed just millimeters from where research on the amount smokers put their lips or fingers when smoking. As a result, many smokers block the vents—which actually of tar and nicotine people turns the light cigarette into a regular cigarette. actually inhale while smoking ➤ Some cigarette makers increased the length of the light cigarettes? paper wrap covering the outside of the cigarette filter, which decreases the number of puffs that occur during ➤ The tobacco industry’s own documents show that the machine test. Although tobacco under the wrap companies are aware that smokers of light cigarettes is still available to the smoker, this tobacco is not compensate by taking bigger puffs.

©2006 WELLNESS COUNCILS OF AMERICA | WWW.WELCOA.ORG ABSOLUTE ADVANTAGE | 29 ABSOLUTE ADVANTAGE WELCOA® “There is no such thing as a safe cigarette. The only proven way to reduce the risk of smoking- related disease is to quit smoking completely.

30 | ABSOLUTE ADVANTAGE ©2006 WELLNESS COUNCILS OF AMERICA | WWW.WELCOA.ORG” ABSOLUTE ADVANTAGE WELCOA® ➤ Industry documents also show that the companies are aware of the difference between machine-measured yields of tar and nicotine and what the smoker KEY POINTS actually inhales. w The lower tar and nicotine What is the bottom line numbers on light cigarette for smokers who want to packs and in ads are protect their health? misleading. w Light cigarettes trick the ➤ There is no such thing as a safe cigarette. The only proven way to reduce the risk of smoking-related smoking machines so that disease is to quit smoking completely. they record artificially low tar ➤ Smokers who quit live longer than those who continue and nicotine levels. to smoke. In addition, the earlier smokers quit, the greater the health benefit. Research has shown that w Light cigarettes provide no people who quit before age 30 eliminate almost all of benefit to smokers’ health. their risk of developing a tobacco-related disease. Even smokers who quit at age 50 reduce their risk of dying w Resources are available for from a tobacco-related disease. people who want to quit ➤ Quitting also decreases the risk of lung cancer, heart smoking. attacks, stroke, and chronic lung disease.

The information in this article was provided by the National Cancer Institute and is in the public domain. For more information, visit their website at www.cancer.gov.

32 | ABSOLUTE ADVANTAGE ©2006 WELLNESS COUNCILS OF AMERICA | WWW.WELCOA.ORG ABSOLUTE ADVANTAGE WELCOA® What is Scientists do not know what amount of exposure to secondhand smoke, if any, is safe. Because it is a secondhand complex mixture of chemicals, measuring secondhand smoke? smoke exposure is difficult and is usually determined by testing blood, saliva, or urine for the presence of Secondhand smoke, also called environmental tobacco nicotine, particles inhaled from indoor air, or cotinine smoke (ETS), is the combination of two forms of smoke (the primary product resulting from the breakdown of from burning tobacco products: sidestream smoke and nicotine in the body) (1, 3). Nicotine, carbon monoxide, mainstream smoke. Sidestream smoke, which makes and other evidence of secondhand smoke exposure have up about half of all secondhand smoke, comes from the been found in the body fluids of nonsmokers exposed burning end of a cigarette, cigar, or pipe (1, 2, 3, 4). to secondhand smoke. Nonsmokers who live with Mainstream smoke is exhaled by the smoker. Exposure to smokers in homes where smoking is allowed are at the secondhand smoke is also called involuntary smoking or greatest risk for suffering the negative health effects of passive smoking (1, 2, 3). secondhand smoke exposure (5). What chemicals What are the health are present in effects of exposure to secondhand smoke? secondhand smoke? Many factors affect what chemicals are present in Secondhand smoke exposure is a known risk factor for secondhand smoke. These factors include the type of lung cancer (1, 3, 4, 6, 7). Approximately 3,000 lung tobacco, the chemicals added to the tobacco, how the cancer deaths occur each year among adult nonsmokers product is smoked, and the paper in which the tobacco in the United States as a result of exposure to secondhand is wrapped (1, 3). More than 4,000 chemicals have been smoke (2). Secondhand smoke is also linked to nasal identified in mainstream tobacco smoke; however, the sinus cancer (1, 4). Some research suggests an association between secondhand smoke and cancers of the cervix, actual number may be more than 100,000 (1). Of the breast, and bladder. However, more research is needed in chemicals identified in secondhand smoke, at least 60 order to confirm a link to these cancers (3, 4, 8). are carcinogens (substances that cause cancer), such as formaldehyde. Six others are substances that interfere with Secondhand smoke is also associated with the following normal cell development, such as nicotine and carbon noncancerous conditions: monoxide (2,4). ➤ chronic coughing, phlegm, and wheezing (4, 6, 7) Some of the compounds present in secondhand smoke become carcinogenic only after they are activated ➤ chest discomfort (4) by specific enzymes (proteins that control chemical ➤ lowered lung function (4, 6, 7) reactions) in the body. After these compounds are activated, they can then become part of a cell’s DNA ➤ severe lower respiratory tract infections, such as and may interfere with the normal growth of cells (5). onchitis or pneumonia, in children (4, 6, 7) In 1993, the U.S. Environmental Protection Agency (EPA) determined that there is sufficient evidence ➤ more severe asthma and increased chance of that secondhand smoke causes cancer in humans and developing asthma in children (6) classified it as a Group A carcinogen (2, 6). In 2000, ➤ the U.S. Department of Health and Human Services eye and nose irritation (4) (DHHS) formally listed secondhand smoke as a known ➤ severe and chronic heart disease (4) human carcinogen in The U.S. National Toxicology Program’s 10th Report on Carcinogens. The most recent ➤ middle ear infections in children (4, 6) report can be found at http://ntp.niehs.nih.gov/ntp/ roc/toc11.html on the Internet. ➤ sudden infant death syndrome (SIDS) (4)

©2006 WELLNESS COUNCILS OF AMERICA | WWW.WELCOA.ORG ABSOLUTE ADVANTAGE | 33 ABSOLUTE ADVANTAGE WELCOA® ➤ low birth weight or small size at birth for babies decade of the 21st century (9). Several objectives of this of women exposed to secondhand smoke during program relate to tobacco use and exposure to secondhand pregnancy (4) smoke, including the goal of reducing the proportion of nonsmokers exposed to secondhand smoke from 65 percent Certain other noncancerous health conditions may to 45 percent by 2010 (9). More information about this also be associated with secondhand smoke. However, program is available on the Healthy People 2010 Web site more research is needed in order to confirm a link at http://www.healthypeople.gov/ on the Internet (9). between these conditions and secondhand smoke. These conditions include: Studies have shown that separating smokers and nonsmokers within the same air space may reduce, but not ➤ spontaneous abortion (miscarriage) (4) eliminate, nonsmokers’ exposure to secondhand smoke ➤ adverse effect on cognition and behavior in (7). Individuals can reduce their exposure to secondhand children (4) smoke by not allowing smoking in their home or car. Educational, clinical, and policy interventions have also ➤ worsening of cystic fibrosis (a disease that causes excessive mucus in the lungs) (4) been shown to reduce secondhand smoke exposure (9). Such policies include adoption of worksite restrictions, How is nonsmokers’ passage of clean indoor air laws, and enforcement of smoking restrictions in shared environments (9). exposure to secondhand On the national level, several laws restricting smoking smoke being reduced? in public places have been passed. For instance, effective In January 2000, the DHHS launched Healthy People January 1, 2005, smoking is banned in all DHHS 2010, a comprehensive, nationwide health promotion and buildings. In other Federal office buildings, smoking is disease prevention agenda designed to help improve the limited to designated areas. Smoking is also banned on health of all people in the United States during the first all domestic airline flights and nearly all flights between

Studies have shown that separating “smokers and nonsmokers within the same air space may reduce, but not eliminate, nonsmokers’ exposure to secondhand smoke.”

34 | ABSOLUTE ADVANTAGE ©2006 WELLNESS COUNCILS OF AMERICA | WWW.WELCOA.ORG ABSOLUTE ADVANTAGE WELCOA® the United States and foreign destinations. All interstate bus travel is smoke free. Smoking is also prohibited or restricted to specially designated areas on trains traveling KEY POINTS within the United States. w Secondhand smoke, also Many states and local governments have passed laws prohibiting smoking in public facilities such as schools, called environmental hospitals, airports, and bus terminals. Some states tobacco smoke (ETS), is also require private employers to create policies that protect employees who do not smoke, and several local the combination of smoke communities have enacted nonsmokers’ rights laws, most emitted from the burning of which are stricter than state laws. More information about state-level tobacco regulations is available through end of a cigarette, cigar, the Centers for Disease Control and Prevention’s (CDC) or pipe, and smoke State Tobacco Activities Tracking and Evaluating exhaled by the smoker. (STATE) System Web site. The STATE System is a database containing up-to-date and historical state-level data on tobacco use prevention and control. This resource w Secondhand smoke is available at http://apps.nccd.cdc.gov/statesystem/ contains at least 60 on the Internet. Although it is still a significant public health concern, nonsmoker exposure to secondhand smoke carcinogens (substances declined by more than 70 percent from 1988–1991 to that cause cancer). 1999–2000 (2). In 1999, nearly 7 out of every 10 U.S. workers reported having a smoke-free policy in their w The known health workplace (2). effects of exposure to secondhand smoke include lung cancer, nasal sinus cancer, respiratory tract infections, and heart disease. w Separating smokers and nonsmokers within the same air space may reduce, but does not eliminate, nonsmokers’ exposure to secondhand smoke.

The information in this article was provided by the National Cancer Institute and is in the public domain. For more information, visit their website at www.cancer.gov.

There are two types of smokeless tobacco--snuff and ➤ Smokeless tobacco users increase their risk for cancer chewing tobacco. Snuff, a finely ground or shredded of the oral cavity. Oral cancer can include cancer of tobacco, is packaged as dry, moist, or in sachets (tea bag- the lip, tongue, cheeks, gums, and the floor and roof like pouches). Typically, the user places a pinch or dip of the mouth. between the cheek and gum. Chewing tobacco is available ➤ People who use oral snuff for a long time have a much in loose leaf, plug (plug-firm and plug-moist), or twist greater risk for cancer of the cheek and gum than forms, with the user putting a wad of tobacco inside the people who do not use smokeless tobacco. cheek. Smokeless tobacco is sometimes called “spit” or ➤ The possible increased risk for other types of cancer “spitting” tobacco because people spit out the tobacco from smokeless tobacco is being studied. juices and saliva that build up in the mouth.

What harmful chemicals are found in smokeless tobacco?

➤ Chewing tobacco and snuff contain 28 carcinogens (cancer-causing agents). The most harmful carcinogens in smokeless tobacco are the tobacco- specific nitrosamines (TSNAs). They are formed during the growing, curing, fermenting, and aging of tobacco. TSNAs have been detected in some smokeless tobacco products at levels many times higher than levels of other types of nitrosamines that are allowed in foods, such as bacon and beer.

➤ Other cancer-causing substances in smokeless tobacco include N-nitrosamino acids, volatile N-nitrosamines, benzo(a)pyrene, volatile aldehydes, formaldehyde, acetaldehyde, crotonaldehyde, hydrazine, arsenic, nickel, cadmium, benzopyrene, and polonium-210.

➤ All tobacco, including smokeless tobacco, contains nicotine, which is addictive. The amount of nicotine absorbed from smokeless tobacco is 3 to 4 times the amount delivered by a cigarette. Nicotine is absorbed more slowly from smokeless tobacco than from cigarettes, but more nicotine per dose is absorbed from smokeless tobacco than from cigarettes. Also, the nicotine stays in the bloodstream for a longer time.

In 1986, the Surgeon “General concluded that the use of smokeless tobacco “is not a safe substitute for smoking cigarettes. It can cause cancer and a number of noncancerous conditions and can lead to nicotine addiction and dependence.”

38 | ABSOLUTE ADVANTAGE ©2006 WELLNESS COUNCILS OF AMERICA | WWW.WELCOA.ORG ABSOLUTE ADVANTAGE WELCOA® What are other ways ➤ An estimated 7.6 million Americans age 12 and older (3.4%) had used smokeless tobacco in the past month. smokeless tobacco can ➤ Smokeless tobacco use was most common among harm users’ health? young adults ages 18 to 25. Some of the other effects of smokeless tobacco use include ➤ Men were 10 times more likely than women to report addiction to nicotine, oral leukoplakia (white mouth using smokeless tobacco (6.5% of men age 12 and lesions that can become cancerous), gum disease, and older compared with 0.5% of women). gum recession (when the gum pulls away from the teeth). Possible increased risks for heart disease, diabetes, and People in many other countries and regions, including reproductive problems are being studied. India, parts of Africa, and some Central Asian countries, have a long history of using smokeless tobacco products. Is smokeless tobacco a good substitute for cigarettes? KEY POINTS In 1986, the Surgeon General concluded that the w use of smokeless tobacco “is not a safe substitute for Snuff is a finely ground or smoking cigarettes. It can cause cancer and a number shredded tobacco that is of noncancerous conditions and can lead to nicotine either sniffed through the addiction and dependence.” Since 1991, NCI has officially nose or placed between the recommended that the public avoid and discontinue the cheek and gum. Chewing use of all tobacco products, including smokeless tobacco. NCI also recognizes that nitrosamines, found in tobacco tobacco is used by putting products, are not safe at any level. The accumulated a wad of tobacco inside the scientific evidence does not support changing this position. cheek. What about using w Chewing tobacco and snuff smokeless tobacco contain 28 cancer-causing to quit cigarettes? agents. Because all tobacco use causes disease and addiction, w Smokeless tobacco users NCI recommends that tobacco use be avoided and have an increased risk of discontinued. Several non-tobacco methods have been developing cancer of the shown to be effective for quitting cigarettes. These methods include pharmacotherapies such as nicotine oral cavity. replacement therapy and bupropion SR, individual and w Several national organizations group counseling, and telephone quitlines. offer information about the Who uses health risks of smokeless smokeless tobacco and how to quit. tobacco? In the United States, the 2000 National Household Survey on Drug Abuse, which was conducted by the Substance The information in this article was provided by the National Cancer Institute and is in the public domain. For more information, visit their Abuse and Mental Health Services Administration, website at www.cancer.gov. reported the following statistics:

hen it come to leading- edge, over-the-top, in- your-face information related to the hazards Wand consequences of tobacco use, there’s no better place than www.thetruth.com. Visited by thousands and thousands of people—many of them young—thetruth. com is a resource that helps to put tobacco use in America in perspective. With creative epidemiology and a fierce focus on an industry that produces products that kills its customers, thetruth.com is committed to informing everyone about tobacco use. With ads appearing on network television, thetruth.com is making significant inroads into becoming the most informative stop on tobacco use in the United States. Check out the statistics and fast facts gleaned from their site.

11. Carbon monoxide is in tobacco 27. There’s hydrogen cyanide in smoke. rat poison. The same stuff is in cigarette smoke. 12. As late as 1999, tobacco companies placed in-store advertising 28. In 1974, a tobacco company signage at a child’s eye level. explored targeting customers as 13. Cigarette smoke contains more young as 14. than 4,000 chemical compounds. 29. In 1984, a tobacco company 14. Cigarette smoking is the number called young adults “replacement one cause of preventable death in smokers.” the U.S. 30. In 1986, a tobacco company’s ad 15. Cigarettes and other smoking agency wrote to a newspaper materials are the number one complaining about the placement cause of fire deaths in the U.S. of their ad next to obituaries. They The truth about tobacco: 16. Cigarette companies advertised said: “We feel that this positioning 1. Every day, cows release methane “light” cigarettes as less harmful was detrimental to our advertising gas into the air. From you know to the smoker, although they can efforts…” where. But methane is also found deliver the same levels of tar and 31. In 1989, millions of cases of somewhere else. Yesiree, in nicotine. cigarette smoke. imported fruit were banned after 17. According to one tobacco a small amount of cyanide was 2. Every year, tobacco-related company VP, in 2001, a company found in just two grapes. There’s disease kills over 178,000 women. name change could focus 33 times more cyanide in a single attention away from tobacco. cigarette. 3. 63% of high school smokers say they want to quit. 18. Every 8 seconds, someone in the 32. In 1993, the Supreme Court world dies from a smoking-related 4. There are 8.5 million people sick decided that an inmate could sue disease. with diseases caused by smoking. a prison claiming that exposure to 19. Every day, cows release methane his cellmate’s secondhand smoke 5. About 1/3 of youth smokers will gas into the air. From you know could constitute cruel and unusual eventually die from a tobacco- where. But methane is also found punishment. related disease. somewhere else. Yesiree, in 33. In 1995, a major tobacco company cigarette smoke. 6. In the U.S., about 440,000 people decided to boost cigarette sales die a tobacco-related death every 20. Every day, about 1,500 youth by targeting homeless people. year. become daily smokers. They called their plan “Project SCUM: Sub Culture Urban 7. About 90% of lung cancer 21. Every single day, in the U.S., the Marketing.” A tobacco company deaths among women who tobacco industry spends about once donated 7,000 blankets to continue to smoke are tobacco $42 million on advertising and homeless shelters in Brooklyn. related. promotions. 8. A tobacco company once gave 22. Every year, cigarettes leave about 34. A Big Tobacco executive once $125,000 worth of food to a 12,000 kids motherless. said, under oath, that he believed charity, according to an estimate Gummi Bears were addictive like by The Wall Street Journal. Then 23. Every year, cigarettes leave about cigarettes. they spent well over $21 million 31,000 kids fatherless. 35. In 2002, U.S. consumers spent telling people about it. I guess, 24. Every day, about 3,900 youth ages about $88.2 billion on tobacco when you sell a deadly, addictive 12 to 17 try a cigarette for the first products. product, you need all the good time. PR you can get. 25. How do infants avoid secondhand 36. In 1985, one tobacco VP said in 9. Babies born to women who smoke? “At some point they reference to smoking-related smoked during pregnancy are begin to crawl.” deaths, “People die in their beds, more likely to be underweight. -- Tobacco Executive, 1996 therefore, should we ban sleep?” 10. By the year 2020, tobacco is 26. Hydrogen cyanide has been used 37. In the past, Big Tobacco has projected to kill about 10 million in prison executions. It’s also compared the addictiveness of people a year worldwide. found in cigarettes smoke. cigarettes to M&M’s.

38. In the past, Big Tobacco has 50. In 1985, a tobacco brainstorming compared the addictiveness of session came up with the idea cigarettes to that of television. of reaching their “younger adult smokers” in candy stores. 39. In the past, Big Tobacco has compared the addictiveness of 51. In 1993, one tobacco company cigarettes to coffee. executive thought it would be a good idea to have his employees 40. In the U.S., about 50,000 people mail “grassroots” complaints die each year from secondhand- to airlines about their smoking smoke-related disease. bans, pretending to be regular customers. 41. Tobacco kills more Americans than auto accidents, homicide, 52. Pee contains urea. So do AIDS, drugs and fires combined. cigarettes.

42. Today, in the U.S., tobacco products 53. “Problems with self-esteem” 61. The tobacco industry increased will kill about 1,200 people. “Has menial boring job” its spending on advertisements “Emotionally insecure” and promotions by $2.7 billion 43. Maternal smoking during “Passive-aggressive” between 2002 and 2003. pregnancy and exposure to secondhand smoke in infancy “Probably leads fairly dull 62. Tobacco companies actually went doubles the risk of Sudden Infant existence” to court to fight for the right to Death Syndrome (SIDS). “Grooming not a strong priority” keep tobacco advertising near “Lacks inner resources” high schools. They won. Congrats, 44. More than 85% of the “top 25” Big Tobacco! films from 1988-1997 contained “Group conformist” tobacco use, and 70%25 of those “Non-thinking” 63. Tobacco companies have been included brand appearances. “Not into ideas” targeting women with their advertising for the last 70 years. Brand appearances were as “Insecure followers” common in films for teen 64. In 1997, one tobacco company CEO These are all terms taken from audiences as for adult audiences said he would probably “instantly” Big Tobacco’s files that have been and were also present in 20% of shut his doors if it was proven used to describe different groups those rated for children. to his satisfaction that smoking of potential customers for their causes cancer. That same company 45. Nicotine has been found in the deadly, addictive products. now admits on their website that breast milk of smokers. 54. Radioactive polonium-210 is smoking causes cancer, but they’re 46. One tobacco company secretly found in cigarette smoke. still open for business. developed a strain of tobacco they 55. Since 1964, there have been 12 65. On its website, one tobacco named “Y1” that contained 50% million tobacco-related deaths in company lists “cancer services” more nicotine. the U.S. as one of the community programs they support. Yet they 47. In 1994, one tobacco company 56. Smoking can lead to cataracts, the continue to make a product that reported finding “insect number one cause of vision loss in leads to 339 deaths from lung infestation” in their cigarettes. the world. cancer each day. 48. In 1989, one tobacco company 57. Smoking during pregnancy results 66. Soups, cereals and other products brainstormed selling its product in the deaths of about 900 infants we consume have to list ingredients from ice cream trucks that drive every year in the U.S. on their labels, but cigarettes, a through neighborhoods. 58. Sunburns can cause wrinkles; so product that kills a third of its users, 49. In 1989, one tobacco company’s can cigarettes. are not required to list any of the 599 possible additives. ideas for reaching minority 59. Because of the tobacco industry’s customers included to “be seen as products, about 339 people in the Source: http://www.thetruth.com a friend,” “build on black history” U.S. die of lung cancer every day. and “help them find jobs.” But All information was taken from they thought that this support 60. The impact of nicotine is jacked thetruth.com. For more information shouldn’t be seen as “a big white up because tobacco companies be sure to visit www.thetruth.com. company’s tactic to sell to blacks.” add ammonia to cigarettes.

MORALTREASON A Former Tobacco Industry Insider Speaks Out n 1988, Jeffrey Wigand, PhD, went to work for Brown & Williamson Tobacco Corporation with the intent of developing a safer cigarette for smokers around the world. Five years later, the former Brown and Williamson Vice President became the industry’s highest ranking executive to speak publicly about its darkest secrets and tactics for finding and keeping a continuous stream of customers willing to buy its dangerous products. Recently, Dr. Wigand sat down with WELCOA President David Hunnicutt to Italk about tobacco use as an ever-present public health concern, the tobacco industry’s desperate tactics for replacing the 460,000 customers who die each year from their product, and what health promotion professionals can do to prevent employees and their families from experiencing the ravages associated with tobacco use.

44 | ABSOLUTE ADVANTAGE ©2006 WELLNESS COUNCILS OF AMERICA | WWW.WELCOA.ORG ABSOLUTE ADVANTAGE WELCOA® In your experience, Dr. Wigand, percent of pregnant mothers still smoke through all three trimesters of their pregnancy. So, many of our unborn how harmful is smoking to children are smoking well-before the time they take their human health? first breath in this world. Tobacco is the only legal product in the world today Addiction starts with the first cigarette, the first dip, or that—when used as intended—kills five million people a the first chew. And it often begins with what’s called a year worldwide. It’s a product that contains anywhere from “gateway product”—a starter product like highly flavored, 4,000 to 8,000 known toxic components. And because it’s moist snuffs. If you’ve ever smoked a cigarette, it’s inhaled directly into the body, those toxic chemicals have physically taxing in terms of coughing, choking, vomiting, access to virtually every organ system in the body. Not to or experiencing headaches. So the industry sells easy-to-use mention the fact that it’s extremely addictive. It’s harmful gateway products in the form of snuffs and chews. To get psychologically in terms of behavior, and it’s harmful people hooked, they often flavor them with licorice, honey, chemically vis-à-vis nicotine, which is four to five times cocoa, spearmint, peppermint, or wintergreen. They’re more addictive than cocaine or heroin. So, is it harmful? initially packaged like little tea bags and always contain There’s no question in my mind—it’s downright dangerous. ammonia or other chemical compounds to facilitate the addictive process. How long do you believe it Addiction is powerful. It doesn’t simply involve the takes someone to become continued use of a product or substance. With an addicted to tobacco? addiction, the user experiences a continually increasing need for more and more of the addictive substance to In all honesty, it varies from person to person. But if you’ve produce the desired effect or feeling. Now that’s powerful. read any of Dr. Joseph DiFranza’s research on tobacco Where addiction really starts to hurt, however, is during addiction, you understand that tobacco addiction is a the withdrawal process. Withdrawal involves a chemical disease that starts with children, not adults. The average withdrawal from the nicotine, and it involves a physical age of a youngster taking up tobacco is somewhere in the withdrawal from the ritual of smoking—the process neighborhood of 12 to14 years of age. And more and more of tapping a cigarette, rolling a cigarette, mouthing a young girls are lighting up today than ever before. In fact, cigarette, and rolling the ashes. So addiction is a process they’re four times more likely to light up than boys the same age. Many young girls believe that having a cigarette with many dimensions. It affects the neural system of the will satisfy their obsession or belief in thinness. And brain, it affects the system that regulates our mood, and it many also believe light or mild cigarettes are a healthier affects the system that produces our flight or fight response. alternative to regular cigarettes—which is absolutely false. In essence, it creates an imbalance of brain chemistry. As a result, if you look at the long-term statistics associated with lung cancer, the rate of increase in lung cancer for There are a surprising number women over the past decade far eclipses that of men. of people out there who refuse It’s important to understand that tobacco addiction is a to believe that the tobacco disease that starts with children. Kids are gaining access to the product at earlier and earlier ages. In fact, kids are companies are manipulating beginning to smoke at earlier ages—around 11 and 12 the nicotine levels in their years old—and approximately 66 percent of these kids purchase the tobacco products themselves. For the most products to facilitate addiction. part, the days when children get tobacco products from What are your thoughts? their parents or friends, or by stealing them, are gone. Sixty-six percent of the kids in this country get tobacco The tobacco industry nurtures a strong belief in the products by purchasing them illegally. “naturalness” of its product with its $14 billion a year in advertising and promotional spending. It’s a belief that Another frightening phenomenon is the number of couldn’t be any further from reality. First, a cigarette children addicted to tobacco from birth. About 20 or pipe tobacco isn’t purely tobacco. Second, both are

©2006 WELLNESS COUNCILS OF AMERICA | WWW.WELCOA.ORG ABSOLUTE ADVANTAGE | 45 ABSOLUTE ADVANTAGE WELCOA® intentionally engineered to contain at least 599 specific the breakdown of sugar when burned. This combination chemicals designed to facilitate the smoking process as of acetaldehyde and free nicotine creates a higher binding well as to enhance the capacity for addiction. Some of capacity in the brain, which aids in the brain chemistry of these additives include chocolate, honey, cocoa, butterfat, addiction. It’s not unlike getting better gas mileage from lemon juice, menthol, and sugars. But that’s not all the your car using ethanol instead of regular gasoline. The industry adds to their product. cigarette is designed to be a highly effective drug delivery device. The chemicals intentionally added to tobacco are The industry also adds chemicals specifically designed to used to enhance addiction, to get nicotine in its most enhance and maintain the addicting process. Nicotine, in addictive form, free nicotine, and to keep the dosage equal its natural state, exists as a salt within the tobacco plant. to what the addict needs for satisfaction. All of this occurs It has a low pH level and therefore isn’t easily transported as part of cigarette and tobacco product design. to or absorbed by the lungs. Knowing this, the industry has discovered a way to make the addictive process and So if I have an addictive need for a gram of nicotine a day, release of nicotine easier. They create what’s called “free I’m going to smoke my cigarettes differently, or smoke nicotine”, and there are very few differences between the more of them to get my fix. I’m going to go ahead and process of making it and the process of freebasing cocaine inhale them deeper and I’m going to therefore feed my (i.e., making crack cocaine). The industry also adds addiction based on what will keep my body from revolting chemicals such as ammonia-based derivatives that have a against withdrawal—that’s the pain of it. high capacity to shift tobacco and smoke pH levels from The last part of all this is what’s unintentionally added acidic to basic. When you take nicotine and move it from to tobacco. Tobacco is also one of the only consumer its naturally acidic environment to a basic environment, products that includes many unintentional additives— where it exists in a cigarette, you scavenge the nicotine in additives derived from the agricultural process, like its free form, which has a higher addictive capacity than pesticide or herbicide residues and bacteria from the soil nicotine in its natural state. where the tobacco plant was harvested. When a cigarette’s Additionally, many of the chemicals added to tobacco— moisture content rises above 15 percent, there’s a tendency like sugars—create other chemicals when they’re burned. for inactive bacteria within the tobacco to begin growing One such chemical is acetaldehyde, which results from and producing very toxic chemicals called aflatoxins.

Tobacco still kills “460,000 people in this country every year. And of the 460,000 people who die, 55,000 of them never chose to smoke—they died from passive or secondhand smoke. ” 46 | ABSOLUTE ADVANTAGE ©2006 WELLNESS COUNCILS OF AMERICA | WWW.WELCOA.ORG ABSOLUTE ADVANTAGE WELCOA® They court “our children in the movies with advertising that leads them to believe cigarette smoking is sexy and glamorous. ©2006 WELLNESS COUNCILS OF AMERICA | WWW.WELCOA.ORG ABSOLUTE ADVANTAGE ” | | 47 ABSOLUTE ADVANTAGE WELCOA® Contrary to what is commonly thought, a cigarette isn’t something we can legislate, nor do I think we should—as a grow-it-in-the-field, stuff-it-in-a-tube product that’s John Stuart Mill would say—“infringe upon somebody shipped out the door. Why is a cigarette so white? Well, else’s liberty or autonomy by legislating something that’s they use titanium oxide on the paper to make it look as an individual decision.” I do think, however, that the white as possible. They use burn accelerants and burn government should regulate tobacco such that it’s not decelerants to keep the cigarette components burning at an considered a normal, run-of-the-mill, everyday consumer equal combustion rate. So there’s a lot of science to it all. product like bread and butter. Tobacco has been a part The science of engineering and designing a cigarette starts of our culture for 200 years, and it constitutes a sizeable in the tobacco field, where genetic engineering can be used portion of revenue for the federal government as well as to boost the nicotine levels in the consumer product. state governments. Every time a pack of cigarettes is sold, the US government and all state governments collect taxes. Do you think smoking is still the The problem is, however, that each time they generate national public health problem revenue from a pack of cigarettes, they also generate a substantial amount of economic burden—in the form it was twenty years ago? of medical costs and lost productivity—from the taxes they’re receiving. To me, it’s a mistake and it doesn’t make Tobacco still kills 460,000 people in this country every economic sense. year. And of the 460,000 people who die, 55,000 of them never chose to smoke—they died from passive or An attempt to make the product illegal would be very secondhand smoke. Secondhand smoke is recognized difficult. The tobacco industry is a $45 billion industry by the EPA, the Registry of Carcinogens, the National where it costs pennies to make their product. For decades Institutes of Health, the American Cancer Society, they’ve been highly influential in terms of preventing the Centers for Disease Control, the World Health Congress and state legislatures from doing the morally right Organization—there is a litany of scientific organizations thing. They’ve worked to prevent smoke-free workplaces, that not only corroborate, but also re-amplify the fact that smoke-free hospitals, and smoke-free schools. It’s only been passive or secondhand smoke—somebody else’s smoke—is recently that we’ve seen some progress due to the enormous a Class A human carcinogen just like asbestos or benzene. amount of documents characterizing the misbehavior of Big Tobacco over the course of the past five decades. We also know that tobacco costs, on a federal level, about $100 billion a year in direct healthcare costs, and about I think a step in the right direction is regulating the $140 billion a year in lost workforce productivity. Smokers tobacco industry. We need to regulate the ingredients are sick more often; they’re out of work more often; they and contents of their product. We need to regulate their need to have breaks more often; and many times they’re labeling practices to prevent them from watering down the just not as productive as non-smokers. Not to mention Surgeon General’s recommendations. We need to regulate the fact that healthcare costs and insurance premiums are their advertising to prevent their predatory messages from higher for smokers. affecting our children. What are your thoughts on Another step we need to take is making better use of the master settlement agreement (MSA) funds—the $246 those companies pushing billion—the states are receiving. We need to use this the envelope by encouraging money for counter-advertisements and smoking cessation their states to pass legislation programs. We need to use this money to enforce our current tobacco age laws. Remember, 66 percent of our children allowing them to only hire non- are purchasing tobacco products from stores and other smokers? legal outlets. The MSA funds need to be seen by the states as an investment in the health and future I think that if an adult chooses to smoke, then they of their citizens. We’ve demonstrated certainly have the right to, so long as it doesn’t affect or that spending the CDC minimum harm others, and so long as the smoker is fully informed recommended 20 percent of those about the risks. Unfortunately, I’m not so sure it’s funds on prevention initiatives

48 | ABSOLUTE ADVANTAGE ©2006 WELLNESS COUNCILS OF AMERICA | WWW.WELCOA.ORG ABSOLUTE ADVANTAGE WELCOA® can demonstrate a 3:1 return on investment in terms of They also prey on people using misinformation. They use healthcare costs and lost productivity. We’ve also seen that monikers such as mild or light, which have no meaning using this money for prevention actually decreases the in terms of the cigarette. They’ve designed the cigarette so number of children using tobacco. that when it’s tested on a machine, it reads a low number. In actuality, the light or ultra light cigarette delivers many The tobacco industry is very powerful, and we need to times the amount of tar and nicotine smoked in a normal recognize that it’s a wholly undesirable power. I think the human manner. So we’ve got people switching to lights or World Health Organization and the European Union are ultra lights believing that they’re being health conscious. beginning to realize that the death toll from tobacco is This is particularly true for women, as more and more 100% preventable. They’re coming to the realization that are choosing lights or milds because they believe they’re they shouldn’t be in bed with the tobacco companies— getting a healthy alternative. That’s why lung cancer rates accepting their political contributions and untruths, and are outstandingly high for women. Instead of getting one creating a system where our children and legislators are type of lung cancer, they get a different kind. blind to the true lethality of tobacco products. I imagine that the tobacco With the tobacco settlements companies see undeveloped, in place, is the tobacco industry third world nations as perfect as powerful and influential as opportunities for continuity. they once were? What are your thoughts? Yes. I don’t think much has changed. There are many foreign countries taking very proactive In 1998, the states’ Attorneys General basically committed steps. Canada is probably leading the pack, followed by to an economic deal. They would get $206 billion in Australia in terms of denormalizing tobacco. They’re payments over 25 years with no strings attached—very raising the prices, restricting advertisements, establishing much different than the original $368 billion from smoke-free environments, placing graphic representations the earlier settlement of June 1997. The money was on tobacco packaging—doing what it takes to save lives. awarded for two purposes: to help states recoup The United States clearly hasn’t come to this. In fact, in damages incurred as the result of treating sick the United States, we use cigarettes as trade barter with smokers, and even more importantly, to help prevent developing countries. children from becoming the new statistics of the When making trade balances, we force developing tobacco industry. In fact, except for four states— countries to take tobacco products as part of the balance Maine, Delaware, Mississippi, and Arkansas—the of trade. The United States fails to recognize the World rest haven’t met the minimum CDC guidelines or Health Organization’s mandate to have a Framework Best Practices for use of the settlement funds to Convention for Tobacco Control (FCTC)—smoke- reverse the toll tobacco takes on our citizens. free environments, price increases on tobacco, tobacco education for children, and a ban on outdoor advertising. By investing the settlement money in prevention, these states could offset the tens of billions of Let’s put this product where it belongs. If it were invented dollars the tobacco industry spends courting our here today, cigarettes wouldn’t be a legal product. In children. They court our children in the movies 2000, the United States Supreme Court essentially cried with advertising that leads them to believe cigarette out for Congress to change the laws regarding the nature smoking is sexy and glamorous. They advertise in of products the FDA could regulate. The court ruled in highly read teen magazines framing the issue as if a 5 to 4 decision that under the 1936 Food Drug and having a cigarette will keep young girls slim. They Cosmetic Act, the FDA didn’t have the power to regulate continually prey on the issue of self-esteem tobacco. Congress has done nothing since 2000 in terms and the dignity of the different shapes, of regulating tobacco, mainly because the tobacco industry sizes, and colors of our children. continues to influence Congress. Once upon a time we

©2006 WELLNESS COUNCILS OF AMERICA | WWW.WELCOA.ORG ABSOLUTE ADVANTAGE | 49 ABSOLUTE ADVANTAGE WELCOA® had a smoke-free White House—it’s no longer smoke free. consistently below the exposure level of a normal human The State of Florida, going back on an earlier decision, smoker. We need to have a fire-safe cigarette that will now invests its pension funds within the tobacco industry. save the lives of innocent firemen, and prevent property All of these actions are due in part because of the tobacco loss due to fire caused by careless smokers. We need to industry’s influence and political motivations. create regulations that allow for the creation of packaging that reminds people about the end effects of the product They told us they couldn’t make a fire safe cigarette. Well, they’re purchasing. Some of the graphic representations New York just passed a fire safe cigarette law and now, done in Canada are truly disturbing, but they give people all of a sudden, the tobacco industry can make a fire safe that pause for thought. We need to work on creating 100 cigarette. They could’ve made one in 1986, but they chose percent smoke-free workplaces and public places. If you not to make one. want to smoke, smoke outside, but don’t smoke where Compared to any other industry, the tobacco industry you’re poisoning somebody else. engages in the most egregious immoral and unethical We also need to start deglamorizing tobacco products in behavior, but continues to go unregulated. Congress the movies and on TV. Contrary to what people think, and many state legislatures won’t help create smoke-free movies depict people smoking more now than they ever environments because they believe doing so will hurt have in the past. And what’s more, 90 percent of the businesses—an absolute falsehood. How would you revenue from the top 10 producing movies comes from like to be a restaurant worker forced to breathe asbestos 11 to 19-year-olds. Does James Bond need to smoke every time you served a meal? Asbestos and secondhand Philip Morris products in his movies? Do Superman and smoke—there’s no difference. Lois Lane ever smoke Marlboros or have a battle with Marlboros in their comic books? Did Fred and Barney In terms of solutions, what can Flintstone smoke Winstons? Should we have allowed the we do to help stop the tobacco amount of smoking we have on TV and in the movies? industry’s plague resulting Should our children get that education? from their products? The CDC has developed a 9-point, Best Practices program to minimize the health toll tobacco takes on The tobacco industry claims tobacco use is a personal our citizens. The program allows for the reduction of choice. Let me assure you it’s not a personal choice when tobacco advertising, increases the costs of tobacco, and you’re an 11-year-old child bombarded with advertisements gives children the power to understand how the tobacco that convey the message that smoking is sexy and cool. industry is attempting to manipulate them. It gives Once upon a time the industry even used cartoon them the power to make critical decisions. The states characters like Joe Camel to entice children. If people participating in this program have demonstrated that think Joe Camel was created for a 25-year-old choosing to they can have a significant impact on the health of middle smoke Camels over Marlboros, they’ve missed the boat. and high school students. They’re saving lives with this Joe Camel was recognized by 31 percent of 3-year-olds— program like Mississippi, Maine, Arkansas and Delaware. more than they recognized Ronald McDonald and Mickey Mouse. That’s how early all of this starts. The first thing The other thing we should be doing is helping those we have to do is create a system to educate our children already afflicted by tobacco addiction. Remember, 90 to see through information displayed on the big screen or percent of smokers want to quit—they only need an TV, and teach them to make rational, critical decisions environment like a smoke-free workplace or be exposed about their health. I try to spend a lot of time working on to counter-advertising to help motivate them to become this. Education is the first thing we should be working on. tobacco-free. We also need to figure out how best to medically intervene to help these folks. We need to figure Second, we have to set requirements by which to regulate out an inexpensive way to break the addiction. Something the tobacco industry. There should be regulations that that combines a nicotine replacement therapy (NRT), require the tobacco industry to disclose tobacco additives, an antidepressant (Zyban), plus behavior modification disclose the true tar and nicotine levels as determined coupled with counseling and dietary and exercise by real smoking, not a machine that measures numbers improvements. Doing so will help create tobacco-free

The people “who know and have access to information about the tobacco industry, but choose to be bystanders, are wrong.” adults. Right now we’re not doing it; we’re not using the they provide “gateway” products? Why do they reimburse money from the tobacco settlements to help people quit. merchants when somebody steals product from a store? So what do we need to get going? Should companies offer free smoking cessation programs? It makes sense. If they There are a lot of things that need to be changed. Unfortunately, what we’re trying to do is unravel two can help someone quit smoking, that person’s risk of a centuries of tobacco normalization in less than a decade. heart attack after one year is the same as someone who We’ve still got a long way to go. The biggest thing we can has never smoked. That’s a pretty good deal, especially do, however, is begin using the settlement funds the way when you consider the costs of a heart attack—financially, they were supposed to be used. State governments haven’t medically, or emotionally. used the money appropriately, and I call it moral treason. There are a lot of questions that need to be answered. These governments don’t believe the settlement money Should we require the tobacco industry to remove belongs to the future—to the children. They don’t believe packaging monikers that suggest a product is a healthier the money should be used to educate our children, to give alternative when in fact it’s more dangerous? Should we them a life unfettered from the ravages associated with require the tobacco industry to tell us the truth when they tobacco. It’s moral treason. know the truth? Should they be allowed to put chemicals like plutonium 210 in their product? Why should they be Why aren’t we hearing these allowed to put chemicals in their product that were never messages, point blank, from intended to be burned, and when burned are downright our political and health leaders? dangerous? Should we allow the industry to claim that the additives they use are safe when they’re not safe and Are the pressures that great? they know they’re not safe? Shouldn’t the government I think some of it has to do with the political action require the tobacco companies—as they do with food and committees funding of these politicians. Much of this cosmetic manufacturers—to list ingredients? How much funding comes from the tobacco industry, and it keeps ammonia do they add to make it more addictive? Why do politicians from acting in a morally responsible manner.

©2006 WELLNESS COUNCILS OF AMERICA | WWW.WELCOA.ORG ABSOLUTE ADVANTAGE | 51 ABSOLUTE ADVANTAGE WELCOA® For a legislator to understand that secondhand smoke I don’t understand why they can’t do the math. I can do kills, and not pass an ordinance preventing people from it; it’s not that difficult. For every prevention dollar you smoking in public places, is morally wrong. spend, you save three dollars in healthcare costs and lost productivity. John Stuart Mill, a 19th-Century utilitarian and libertarian, believed that the only time government had the duty to interfere with somebody else’s liberty What advice do you have for or autonomy was when that autonomy or liberty hurt worksite leaders, doctors, and others. Secondhand smoke hurts the innocent. I also strongly believe in another principle that is written on a health educators regarding marble plaque at the Holocaust Museum in Washington, what they can do to prevent the DC: “Thou shalt not be a victim…Thou shalt not further spread of tobacco use? be a perpetrator…But above all, thou shalt not be a bystander.” The people who know and have access to First and foremost, don’t be a bystander. We have too information about the tobacco industry, but choose to be many doctors across the nation who won’t actively take bystanders, are wrong. part in solving this epidemic. We need more medical practitioners to get involved like the American Academy of Dr. Wigand, what’s your take on Family Medicine has. We need more dentists involved. We the tobacco industry providing need policemen out there making sure that the 66% of the cigarettes purchased by underage children aren’t acquired smoking cessation websites because laws aren’t being enforced. and other health interventions? We need to make the price exorbitantly high—just like It’s more of an enticement for our children to smoke. New York State did—so the barrier to entry becomes a It passes the responsibility from the tobacco company significant hurdle. For a child to afford eight bucks for to whom? To the parent of the child or to the child a pack of cigarettes is difficult. We know that for every themselves. The responsibility belongs to the tobacco 10 percent increase in the price of cigarettes, there’s a industry. The tobacco companies don’t survive by getting 7 percent decrease in the consumption or purchasing 25-year-olds to smoke. Ninety percent of those people capacity of a child, and 4 percent decrease among adults. smoking today didn’t start after the age of 18 or 19; they We know that 90 percent of those people hooked and started before. We’ve got to counter the tobacco companies addicted to tobacco want to do one thing—break their tactics with ads like the TRUTH ads that have come out addiction. But these people need help. Maybe it’s paying of Florida. Those ads have been so successful because for pharmaceuticals, or providing access to a program to adults didn’t create them. They were created by children— help free them of their addiction. Sometimes what they the body bags, the lie detectors, and so on, have helped need is a smoke-free environment, a smoking cessation create an understanding of how the tobacco companies course, or just a counter-advertisement. People have manipulate and target our children. written and told me that they no longer want anything to do with smoking after watching the movie The Insider. But the cycle continues. I go to places, not only in the What they saw actually helped them quit smoking. United States, but throughout the world, where kids six, seven, or eight years old are already smoking, chewing, There are many different ways of skinning this cat. But we or dipping. If we were spending the money to help these need our legislators; we need people from all walks children understand that using tobacco is risky behavior, of life to actively engage in the process of denormalizing to help them understand why it’s fatal and how they’re the tobacco industry’s products. being manipulated, we could make a difference. At the

same time, if we could get our legislative bodies to realize All information ©Wellness Councils of America (WELCOA) 2006. that if they spent only 20 percent of the settlement dollars WELCOA provides worksite wellness products, services, and information to thousands of organizations nationwide. For more information visit on tobacco prevention efforts, they would make a big www.welcoa.org. difference in the lives of these children, not to mention Suggested Citation: Moral Treason: A Former Tobacco Industry Insider Speaks Out. produce a 3:1 return in terms of healthcare costs. (2006). WELCOA’s Absolute Advantage Magazine, 5(2), 44-53.

Tobacco companies “don’t survive by getting 25-year-olds to smoke. 90% of those people smoking today didn’t start after the age of 18 or 19; they started before.”

54 | ABSOLUTE ADVANTAGE ©2006 WELLNESS COUNCILS OF AMERICA | WWW.WELCOA.ORG ABSOLUTE ADVANTAGE WELCOA® elping your employees After you’ve quit, the urge to smoke Here’s what you can do if this happens: lead tobacco-free lives often hits at the same times. For many >> Understand that you’ve had a is challenging. Given people, the hardest place to resist the slip. You’ve had a small setback. the addictive nature of urge is at home. And many urges hit This doesn’t make you a smoker Hcigarettes, many employees struggle when someone else is smoking nearby. again. Don’t be too hard on with quitting—especially over the Look at your Craving Journal to see yourself. One slip up doesn’t long haul. when you might be tempted. Then make you a failure. It doesn’t So what information can you give use the skills you’ve learned to get mean you can’t quit for good. them? through your urges without smoking. >> Don’t be too easy on yourself Great question. Basically, to help Fight The Urges either. If you slip up, don’t say, those employees who have already “Well, I’ve blown it. I might Drink water, walk, chew gum, go to as well smoke the rest of this quit and those employees who are support groups, watch a movie. Do pack.” It’s important to get back looking to quit, the messages are anything to fight the urge to smoke. on the non-smoking track right relatively straightforward. Stay Upbeat away. Remember, your goal is no In the paragraphs below and the cigarettes—not even one puff. As you go through the first days pages that follow, we’ve provided >> Feel good about all the time and weeks without smoking, keep information that can help you get you went without smoking. a positive outlook. Don’t blame or the job done. All of the information Try to learn how to make your was provided by the National Cancer punish yourself if you do have a coping skills better. cigarette. Don’t think of smoking as Institute and can be reprinted >> Find the trigger. Exactly what “all or none.” Instead, take it one day without permission. Be sure to use was it that made you smoke? Be at a time. Remember that quitting is this information in your worksites aware of that trigger. Decide now a learning process. and with your clients. how you will cope with it when it Keep Rewarding Yourself comes up again. Stick With It Now that you aren’t buying cigarettes, >> Learn from your experience. What has helped you the most to Helping your employees to beating you probably have more spending keep from smoking? Make sure an addiction to nicotine takes a lot money. For example, if you used to do that on your next try. of will-power and determination. to smoke one pack per day: Think Your employees who have quit about starting a “money jar” if you >> Are you using a medicine to should feel great about themselves haven’t already. Put your cigarette help you quit? Don’t stop using your medicine after only one or for making it this far. Now’s the time money aside for each day you don’t two cigarettes. Stay with it. It to focus on helping them stick with smoke. Soon you’ll have enough will help you get back on track. it. Specifically, here’s what you can money to buy a reward for yourself. confidently share with them. >> Know and use the tips in this If You Do Slip Up booklet. People with even one Keep Your Guard Up Don’t be discouraged if you slip up coping skill are more likely to Your body has changed since you and smoke one or two cigarettes. stay non-smokers than those who began to smoke. Your brain has It’s not a lost cause. One cigarette is don’t know any. learned to crave nicotine. So certain better than an entire pack. But that >> START to stop again! places, people, or events can trigger a doesn’t mean you can safely smoke >> See your doctor or another strong urge to smoke, even years after every now and then… no matter how health professional. He or she quitting. That’s why you should never long ago you quit. One cigarette may can help motivate you to quit take a puff again, no matter how long seem harmless, but it can quickly lead smoking. back to one or two packs a day. it has been since you quit. At first, The previous information can be you may not be able to do things Many ex-smokers had to try stopping used in coaching sessions by wellness as well as when you were smoking. many times before they finally practitioners to help quitters remain Don’t worry. This won’t last long. succeeded. When people slip up, it’s smoke-free. The information on the Your mind and body just need to get usually within the first three months following pages can help you coach used to being without nicotine. after quitting. smokers through the quitting process.

©2006 WELLNESS COUNCILS OF AMERICA | WWW.WELCOA.ORG ABSOLUTE ADVANTAGE | 55 ABSOLUTE ADVANTAGE WELCOA® ¸ If you smoke at work, quit on ü Ask everyone to understand Here’s How To the weekend or during a day your change in mood. Get STARTed off. That way you’ll already be Remind them that this won’t cigarette-free when you return. last long. (The worst will be Just thinking about quitting may over within two weeks.) Tell make you anxious. But your chances Tell People Of them this: “The longer I go will be better if you get ready first. Your Plan To Quit without cigarettes, the sooner Quitting works best when you’re ¸ Quitting smoking is easier I’ll be my old self.” prepared. Before you quit, START by with the support of others. ü Does someone close to you taking these five important steps: Tell your family, friends, and smoke? Ask them to quit with Set a quit date. co-workers that you plan to quit. you, or at least not to smoke S Tell them how they can help you. around you. Tell family, friends, and co- ¸ Some people like to have ü Do you take any medicines? T workers friends ask how things are Tell your doctor and pharmacist going. Others find it nosy. Tell you are quitting. Nicotine Anticipate and plan for the the people you care about exactly changes how some drugs work. A challenges you’ll face while how they can help. Here are You may need to change your quitting. some ideas: prescriptions after you quit. Remove cigarettes and other R tobacco products from your home, car, and work.

Talk to your doctor about T getting help to quit.

Set A Quit Date

¸ Pick a date within the next two weeks to quit.

¸ Be sure to give yourself enough time to get ready. But don’t wait so long that you lose your drive to quit.

¸ Think about choosing a special day: ü Your birthday or wedding anniversary ü New Year’s Day ü Independence Day (July 4) ü World No Tobacco Day (May 31) ü The Great American Smokeout (the third Thursday of each November)

56 | ABSOLUTE ADVANTAGE ©2006 WELLNESS COUNCILS OF AMERICA | WWW.WELCOA.ORG ABSOLUTE ADVANTAGE WELCOA® ü Get support from other ü Feeling anxious, nervous, or cigarettes. Smokeless tobacco, people. You can try talking restless cigars, pipes, and herbal cigarettes also harm your with others one-on-one or in a ü Having trouble thinking health. For example, bidi group. You can also get support clearly on the phone. You can even try cigarettes are just as bad as ü an Internet chat room. This Feeling hungry or gaining regular cigarettes. Clove kind of support helps smokers weight cigarettes are even worse. quit. The more support you Not everyone has feelings of They have more tar, nicotine, and deadly gases. All tobacco get, the better. But even a little withdrawal. You may have one products have harmful can help. or many of these problems. And chemicals and poisons. they may last different amounts Anticipate The of time. Talk To Challenges Ahead Remove All Your Doctor ¸ Expecting challenges is an Tobacco Products important part of getting ready ¸ Quitting “cold turkey” isn’t to quit. Most people who go back ¸ Getting rid of things that your only choice. Talk to your to smoking do it within three remind you of smoking will doctor about other ways to quit. months. Your first three months also help you get ready to quit. Most doctors can answer your may be hard. You may be more Try these ideas: questions and give advice. They tempted when you are stressed ü Make things clean and fresh can suggest medicine to help or feeling down. It’s hard to be at work, in your car, and at with withdrawal. You can buy ready for these times before they home. Clean your drapes and some of these medicines on your happen. But it helps to know clothes. Shampoo your car. own. For others, you need a when you need a cigarette most. Buy yourself flowers. You will prescription. enjoy their scent as your sense ¸ Look over your Craving of smell returns. Your doctor, dentist, or pharmacist Journal. See when you may can also point you to places to find be tempted to smoke. Plan ü Throw away all your support or toll-free quit lines. for how to deal with the urge cigarettes and matches. Give If you cannot see your doctor, you before it hits. You should also or throw away your lighters and ashtrays. Remember the can get some medicines without expect feelings of withdrawal. ashtray and lighter in your car! a prescription that can help you Withdrawal is the discomfort quit smoking. Go to your local of giving up nicotine. It is ü Have your dentist clean your pharmacy or grocery store for your body’s way of telling you teeth to get rid of smoking over the counter medicines like it’s learning to be smoke-free. stains. See how great they look. These feelings will go away in Try to keep them that way. the nicotine patch, nicotine gum, time. Keep reading for tips on or nicotine lozenge. Read the ü Some smokers save one pack handling urges and withdrawal. instructions to see if the medicine of cigarettes. They do it “just is right for you. ¸ Withdrawal: How You May in case.” Or they want to prove Feel When You Quit. Common they have the willpower not to If you’re not sure, ask a feelings of smoking withdrawal smoke. Don’t! Saving one pack pharmacist. include: just makes it easier to start smoking again. ü Feeling depressed ü Don’t use other forms of The information in this article was ü Not being able to sleep provided by the National Cancer tobacco instead of cigarettes. Institute and is in the public domain. For ü Getting cranky, frustrated, Light or low-tar cigarettes more information, visit their website at www.cancer.gov. or mad are just as harmful as regular

©2006 WELLNESS COUNCILS OF AMERICA | WWW.WELCOA.ORG ABSOLUTE ADVANTAGE | 57 ABSOLUTE ADVANTAGE WELCOA® Where There’s Smoke... There’s A New Kind Of Fire Some Companies Are Sending A Message To Employees, “If You Choose To Smoke—Even On Your Own Time—Hit The Bricks.”

| By David Hunnicutt, PhD

58 | ABSOLUTE ADVANTAGE ©2006 WELLNESS COUNCILS OF AMERICA | WWW.WELCOA.ORG ABSOLUTE ADVANTAGE WELCOA® EYCO, Inc. a is no law in Michigan that prevents Railroad, according to a recent Wall Michigan-based Third an employer from taking this kind Street Journal article, is relying on W Party Administrator of action. the honor system to weed out tobacco specializing in Employee Benefit users—they have implemented a Since the firing of the WEYCO Plans and Benefit Management, question that potential employees will employees, a lawsuit has been filed has implemented a new corporate have to answer when completing a against CEO Howard Weyers and policy: If you smoke, you’re fired. job application. WEYCO, Inc. As one would have According to WEYCO’s website predicted, this issue will now be To support those current employees (www.weyco.com), the company played out in the courts. who were already tobacco users, believes “in having a proactive plan UPRR offers assistance to help them for promoting healthy lifestyles for WEYCO’s Not The First quit using tobacco. employees.” The leaders at WEYCO believe that “healthy employees are Or The Only Because of these kinds of efforts, more productive and, long term, the While national media attention has Union Pacific Railroad has seen its healthcare costs can be lessened.” propelled WEYCO’s anti-smoking tobacco using population shrink stance into the spotlight, it is far Based on its company ethos, it is clear from 40% of its workforce in 1990 from the only company attempting to 27% in 2003. that the leadership at WEYCO backs to improve employee health and up its words with action. contain potentially modifiable health One of the most recent companies In recent months, WEYCO fired four care costs by regulating employee to take on a WEYCO-like approach of its employees when they refused behaviors. is Scotts Miracle-Gro Company. Located in Columbus, OH, Scotts to take a breathalyzer test—which For example, Fortune 500 giant, Miracle-Gro is implementing a would detect whether or not a person Union Pacific Railroad recently policy of firing employees who light was a tobacco user—under new rules announced that tobacco use up—even at home. This policy will imposed by the company. would be banned anywhere on its go into full force in October of 2006, Prior to its showdown with these main property—inside or out. and it will be interesting to watch four, WEYCO gave all employees In addition, it also announced that this company’s story unfold. fifteen months to quit before in Omaha, NE (its headquarters subjecting them to random breath location) and seven other states, Big Brother Or Big Stink? testing. In fact, of the company’s 24 UPRR would not be hiring Should tobacco users be fired? Do tobacco users, 20 quit. tobacco users. employers have the right not to hire By taking this kind of “proactive” Unlike WEYCO, Union Pacific tobacco users? Do policy makers action, WEYCO became national news. In recent Major media such as CNN, CBS, ABC, and many others ran national months, WEYCO stories scrutinizing the merits of “ WEYCO’s approach to health fired four of management. The WEYCO story its employees became fodder for intense debate between pro-health advocates and when they privacy protectionists. In addition, the ACLU was contacted on behalf refused to take of the fired employees to explore whether the move by WEYCO was a Breathalyzer even legal. test... The findings were clear: It was, indeed, perfectly legal. In fact, there ” ©2006 WELLNESS COUNCILS OF AMERICA | WWW.WELCOA.ORG ABSOLUTE ADVANTAGE | 59 ABSOLUTE ADVANTAGE on the health-related consequences experienced by tobacco users. This is also the case for non-tobacco users who will also help to subsidize the consequences of this unhealthy behavior. With health care costs approaching $1.8 trillion and health care becoming a precious resource, tobacco use policies and restrictions in the United States are only going to draw more attention.

have the right to draft, propose, employee populations, and The Bottom Line and implement legislation that geographic locations—get this… Clearly, firing tobacco users is a forbids employers from being able operate differently. Thus, it would very controversial issue. Not hiring to take this kind of stance on be reasonable to think that different tobacco users is not as controversial, tobacco-related issues? companies would have vastly but remains a highly debated business different approaches to promoting practice. For those of us committed Given the number of companies health and preventing disease. to building healthier places to work, who are not only adopting worksite improving employee health, and wellness as a standard company For example, would we assume that containing runaway health care practice, but implementing aggressive the business (and health) practices of costs, these kinds of issues will force tobacco-restriction policies to GE are consistent with that of Ben & us as professionals to think through promote health and contain costs, Jerry’s? Probably not—each company how we feel about them—and where it is clear that corporate leaders are is inherently different but both are exactly we draw the line. developing their own ideas on how successful in what they do. Each have their own way of implementing to best address tobacco use within REFERENCES important change initiatives their own corporate frameworks. 1. Snow, Mary. No Smoking. January 26, And many of them are pushing the consistent with corporate culture 2005. http://www.cnn.com/2005/US/01/26/ no.smoking/index.html traditionally-defined boundaries— and standard operating practices. To 2. Safer, Morely. Whose Life Is It Anyway? remaining well within the confines think that one-size fits all, especially October 30, 2005. http://www.cbsnews.com/ stories/2005/10/28/60minutes/main990617. of state and federal laws as well as when it comes to something like shtml?CMP=ILC-SearchStories abiding by non-discriminatory and tobacco cessation, is naïve. 3. Stossel, John. Where There’s Smoke, fair hiring practices. They’re Fired. April 8, 2005. http:// In the meantime, while the abcnews.go.com/2020/GiveMeABreak/ story?id=650390&page=1 What’s most interesting about this acceptability of different cessation 4. Banzhaf, John. ASH Press Release: Firing practices continues to be scrutinized, Smokers Protects Nonsmokers – Weyco Only is that the variety of employer- Latest. January 30, 2005. http://no-smoking. approaches—from nurturing and tobacco-related illnesses remain org/jan05/01-31-05-6.html supporting tobacco users in their the leading cause of death among 5. Gunn, Eileen. No Ifs, Ands or Butts: Smokers Need Not Apply. http://www.careerjournal. quest to quit, all the way to firing Americans killing nearly 450,000 com/hrcenter/articles/20041214-gunn.html those who don’t comply with people each year. Presently, tobacco 6. Siegel, Michael. Anti-Smoking Interventions kills more Americans than auto May Have Set the Stage for Discriminatory company mandates—appear to be Employment Policies. December 12, 2005. producing outcomes. accidents, homicides, AIDS, drugs, http://tobaccoanalysis.blogspot.com/2005/12/ and fires combined. What’s more, anti-smoking-interventions-may-have.html This may very well be a key 50,000 people die each year from understanding that allows all of us to secondhand smoke related diseases. All information ©Wellness Councils of America (WELCOA) 2006. WELCOA address this issue with more decorum If left unchecked, by the year 2020, provides worksite wellness products, and thoughtfulness. tobacco is projected to kill about 10 services, and information to thousands of organizations nationwide. For more information million people a year worldwide. visit www.welcoa.org. Different companies with Suggested Citation: Hunnicutt, D. (2006) Where qualitatively different mission Corporations will be forced to pick There’s Smoke...There’s A New Kind Of Fire. WELCOA’s statements, ways of doing business, up a significant portion of the tab Absolute Advantage Magazine, 5(1), 58-60.

The Burden Of Tobacco Use

An estimated 45.8 million adults in the United States smoke Tobacco Use At cigarettes, even though this single behavior will The Workplace result in death or disability for half of In this issue of Absolute Advantage we’ll address all regular smokers. the topic of tobacco use at the workplace. Although often times neglected—largely due to the nation’s new focus on Page 2 obesity—tobacco use is a critical issue that every employer needs to address. 4 50 Great Ideas To Help Your With healthcare costs approaching 1.8 trillion and Employees Quit Smoking healthcare becoming a precious resource, proactive If you’re looking for easy-to-implement ideas to help you address employers are taking bold and aggressive steps to smoking at the workplace, you’ll find this article helpful. stemming the tide of tobacco use at the workplace. 20 Notable & Quotable These maxims, mantras, and notable quotes about smoking and In this issue, we’ll examine the burden of tobacco tobacco use will make you stop and think. use in the United States. Even for the most hardened of 24 Q&A: Cigar Smoking skeptics, the statistics are simply staggering. Cigars remain a leisure pursuit for many Americans. However, the risks of cigar smoking are very real. Having provided an aerial view of the issue, we’ll 28 Q&A: “Light” Cigarettes delve into a series of articles addressing commonly asked Recently, there’s been a lot of discussion and controversy questions about cigarettes, cigars, and smokeless tobacco. surrounding “light” cigarettes. Get the real story.

To help you in your quest to address tobacco use at 32 Q&A: Secondhand Smoke Secondhand smoke will kill 50,000 people in the US. Find out what the workplace, we’ve provided dozens of easy-to-implement the health effects of secondhand exposure really are. ideas. We’ve also highlighted a fascinating website— 36 Q&A: Smokeless Tobacco www.thetruth.com. In addition, we’ll share an interview Although smokeless tobacco is commonly overlooked, it remains an done with Jeffrey Wigand, a former tobacco industry important issue of any tobacco cessation initiative. insider. Finally, we’ll examine a case study of Weyco, Inc., 40 The Truth Is Found a company that has set a policy to fire its smokers. The nationally recognized webiste, thetruth.com is an intriguing and enlightening place to visit. To discover the truth, read on. I hope you enjoy this issue. I’d like to recognize the National Cancer Institute for developing and making 44 Moral Treason: A Former Tobacco Industry Insider Speaks Out available much of the information contained in this issue. Jeffrey Wigand, the mythical figure that the movie The Insider was based on, speaks out about what he knows from his days as a Yours in good health, tobacco scientist.

54 Helping Your Employees Live Tobacco Free Check out this step-by-step approach to help your employees kick the habit. Dr. David Hunnicutt 58 Where There’s Smoke...There’s A President, Wellness Councils of America New Kind Of Fire Employers are taking aggressive and bold measures to address smoking in the workplace. Don’t miss this article.