Susan M. Zbikowski, PHD, Senior Vice President, Research, Training, & Evaluation 

I am pleased to announce that Alere Wellbeing had an important paper published this month in the Journal of Environmental and Public Health. Our article, “The 2009 US Federal Cigarette Tax Increase and Quitline Utilization in 16 States,” written by Terry Bush, Susan Zbikowski, Lisa Mahoney, Mona Deprey, Paul D. Mowery, and Brooke Magnusson, describes call volumes to 16 state quitlines, characteristics of callers, and cessation outcomes before and after the 2009 federal tax increase.

You may remember back to 2009 when smokers were once again hit with a large increase in the cost of their cigarettes. On February 4, 2009, the federal government enacted a 62-cent increase in the federal cigarette tax, along with increases in other tobacco taxes, to fund expansion of the State Children’s Health Insurance Program. The federal cigarette tax increased to $1.01 per pack on April 1, 2009. Right before the increase in cigarette tax was made public, tobacco companies sneaked in their own price increase on tobacco products. This dramatic increase in the costs of smoking was likely to be a tipping point for smokers to try to quit. With support from the Centers for Disease Control and Prevention (CDC), researchers at Alere Wellbeing decided to find out if these increased costs would result in more people calling state quitlines for help.

Results of this study were just released in the Journal of Environmental and Public Health. The study showed that the federal excise tax on cigarettes was associated with a 23.5% increase in calls to quitlines and attracted somewhat different types of smokers compared with the year before the tax. In particular, it seems that the tax had a greater impact on those who had less education and who were living with other smokers based on the increase in calls from this demographic. Although we also expected that more young smokers would call, this was not the case in this study.

Another important finding from the study was that quit rates among those who called after the tax increase did not differ from quit rates among those who called before the tax increase. The lack of a significant increase in quit rates is not surprising since the participating quitlines did not provide additional or different services to callers. Nonetheless, increasing the number of callers at the same quit rate means an increase in total number of successful quitters. In these 16 states, of the 19,911 additional tobacco users who called during the time of the tax an additional 5,714 would quit smoking (19,911 more callers after tax ∗ 28.7% quit rate).

If the money raised from increased taxation on cigarettes was put into cessation treatment, then it is likely the taxes would have an even greater effect on helping smokers to quit. Numerous studies have shown that quitlines increase ones chances for quitting, especially when multiple counseling calls plus nicotine replacement medications are made available. Unfortunately, states have been cutting back on the services they provide on order to contain costs. This study from Alere Wellbeing provides important data relevant to public health policy on tobacco control. Providing evidence-based cessation services combined with tax and price increases, smoke-free laws, anti-tobacco advertising, and bans on promoting tobacco use can increase quit rates and decrease the prevalence of tobacco use.

Ariyah DeSouza, Recruitment Marketing Manager

Contrary to popular belief, Cinco de Mayo is not Mexico's Independence Day, which is actually in September. Spanish for “fifth of May,” Cinco de Mayo is observed in the United States as a celebration of the culture and experiences of Americans of Mexican ancestry, much as St. Patrick's Day, Oktoberfest, and the Chinese New Year are recognized to celebrate those of Irish, German, and Chinese ancestry. Similar to these holidays, Cinco de Mayo is observed by many Americans regardless of ethnic origin.

This Cinco de Mayo, millions of Americans will go out with friends for tequila and tacos. Countless bars and restaurants will offer celebratory fare and drinks. For people trying to quit tobacco, social gatherings involving alcohol can trigger the urge to smoke or chew.

Our clients can connect their employees or members with help to combat these urges through timely outreach. Our Cinco de Mayo Promotion – in both English and Spanish – reminds tobacco users that the Quit For Life® Program can help anyone resist tobacco, even when they’re surrounded by environmental temptations. A certified Quit Coach® works with each participant to strategize on how to combat cravings given real life situations.

Your tobacco users are always welcome to join our Quit For Life® Facebook page for further quit support. Our latest Facebook badges were designed for those who want to specially recognize this Cinco de Mayo by quitting tobacco.

And remember to have a ¡feliz Cinco de Mayo!

Ariyah, Recruitment Marketing Manager at Alere Wellbeing, is responsible for the creation of thematic content and promotional campaigns for the program-eligible populations of Alere Wellbeing clients. Follow her blog series, Beyond Employee Benefits Communications, for ideas on how to creatively communicate employee health benefits at your organization.

Visit www.alerewellbeing.com to learn about Alere Wellbeing’s Quit For Life® Program, the only commercial tobacco cessation program in the U.S. with proof of effectiveness published in multiple peer-reviewed scientific journals over the course of 25 years. Quit For Life® is now also available in Spanish. Read the press release.

Erin Thompson Curlett, Senior Content & Social Media Marketing Manager

We're happy to announce that on May 15 and May 22, Alere Wellbeing will host the complimentary live webinar, Deconstructing DASH: How Your Workforce Would Benefit from America's #1 Rated Diet. Obesity expert, Dr. Robert F. Kushner, Clinical Director of the Northwestern Comprehensive Center on Obesity, will provide an overview of DASH, compare it with other top-rated diets, and offer insight into the evidence behind its design. He will also discuss the keys to sustainable weight loss and best practices for employers selecting a worksite weight loss plan.

Webinar Description

With so many diets on the market to choose from, how do you choose the diet that is best for your employees and will deliver substantial, sustainable results that will improve their health and help lower your healthcare costs?

In January, U.S. News & World Report released its list of Best Diets for 2012. For the second year in a row, the government-endorsed Dietary Approaches to Stop Hypertension (DASH) Diet, came in first.

As a human resource professional, you know you would be hard pressed to find an adult at your organization who doesn't want to lose weight, improve their health, and increase energy. It's likely many of your employees have tried to lose weight on a diet, and after many failed attempts are at an impasse. It's time to find a sustainable solution.

Join us for our latest Clear Insights webinar , Deconstructing DASH: How Your Workforce Would Benefit from America's #1 Rated Diet, presented by Robert F. Kushner, MD, Clinical Director of the Northwestern Comprehensive Center on Obesity and one of the 22 expert panelists who rated the Best Diets for 2012. Dr. Kushner will provide an overview of DASH, compare it to other top-ranked diets, and offer insights into the evidence behind their design. Dr. Kushner will also discuss the keys to sustainable weight loss and best practices for employers to choose an effective worksite weight loss plan.

Dr. Robert Kushner

Dr. Kushner’s approach to sustainable weight loss includes improving diet, increasing physical activity, and engaging in personalized behavior change, as well as pharmacotherapy and bariatric surgery when appropriate. Dr. Kushner formerly served as president of The Obesity Society (TOS), the American Society for Parenteral and Enteral Nutrition (ASPEN), and the American Board of Physician Nutrition Specialists (ABPNS). He is currently the first president of the new American Board of Obes

ity Medicine (ABOM) and a board member of the Obesity Action Coalition (OAC). He is on the editorial board for Obesity and the Journal of the American Dietetic Association.

Visit Clear Insights to register today.

Visit www.alerewellbeing.com to learn about Alere Wellbeing’s Weight Talk®, an evidence-based personal coaching program built on the DASH Diet and designed to achieve measurable, sustainable weight loss.

Ariyah DeSouza, Recruitment Marketing Manager

In May 2011, the Centers for Disease Control and Prevention (CDC) reported on a study showing that cigarette package health warnings increase interest in quitting among smokers. The data revealed that warnings do influence smokers’ desire to quit. This finding is precisely why tobacco companies are fighting federal regulation of tobacco packaging, namely the addition of graphic warnings – which are mandated in dozens of other countries.

The fact that graphic warnings really work inspired our marketing team: why not use warning labels to promote our tobacco cessation program? A compelling campaign featuring warning labels could elicit prospective participants’ attention. And since we know from experience that, for our participants, emotional reasons (rather than scientific reasons) are what stir them to seek support for quitting tobacco, why not focus on the benefits of quitting rather than the damage to health caused by smoking?

So came to be the new Graphic Warnings Campaign for the Quit For Life® Program. Mirroring the look of the Surgeon General’s warnings on tobacco packaging, the campaign’s warnings are immediately recognizable as a positive spin on current text-only labels. Our warnings – like “Quitting Tobacco Will Put More Money in Your Wallet” – remind program-eligible populations of why they want to quit and get support to quit, rather than scare them into trying to quit. Our clients can quickly launch and easily manage the Graphic Warnings Campaign using tips in the Campaign Summary, which we include in each campaign package.

Warning labels work, and a positive spin on them will help motivate your program-eligible populations to quit for good.

Ariyah, Recruitment Marketing Manager at Alere Wellbeing, is responsible for the creation of thematic content and promotional campaigns for the program-eligible populations of Alere Wellbeing clients. Follow her blog series, Beyond Employee Benefits Communications, for ideas on how to creatively communicate employee health benefits at your organization.

Visit www.alerewellbeing.com to learn about Alere Wellbeing’s Quit For Life® Program, the only commercial tobacco cessation program in the U.S. with proof of effectiveness published in multiple peer-reviewed scientific journals over the course of 25 years.

Yuki Yang, Vice President of Client Services

Last week I wrote about the growing trend of employers to administer cotinine tests (otherwise known as nicotine tests) to verify employees’ tobacco use status in light of hefty healthcare discounts offered to nonsmokers through premium differentials programs. Today I’m going to share with you some best practices on how to set up a nicotine-testing policy at the worksite.

Before I go any further, it’s important to mention that at Alere Wellbeing, we don’t believe that nicotine tests are necessary to prove a person’s abstinence from tobacco. Studies have shown that nicotine tests often validate that the honor system usually does work. However, given the dollar value of premium differentials, we do see a place for randomized nicotine testing.

Random testing can act as a deterrent to dishonesty.

Employers may opt to randomly administer the test to employees who claim to be tobacco free when premium differentials are offered. Used in this way, the test acts as a deterrent to employees who may otherwise be dishonest about their tobacco use in order to obtain the incentive.

Testing new employees can ensure compliance with a no-hire policy for tobacco users.

Employers may also test new employees who join organizations with a no-hire policy for tobacco users. It’s important to note that many states have anti-discrimination laws around this issue (sometimes known as "smokers' laws" or "lifestyle laws"), so we recommend the consultation of appropriate resources prior to implementation of a nicotine test.

There are a few ways companies can ensure that employees are on board with the implementation of nicotine testing as a part of their premium differential plan:

• Randomly test employees. The random nature of the test will encourage those who may be tempted to lie about their tobacco use to be more truthful or take advantage of the opportunity to quit.
• Clearly communicate why the tests are being administered. Make sure employees understand that the purpose of the test is to help support the premium differentials program, which is intended to encourage the entire workforce to make healthy decisions. Keep communications positive and encouraging. Also clearly communicate the available options if an employee tests positive.
• Do not respond to a positive test with punishment. Instead, use the results as a “teaching moment,” taking into account the possibility of a false negative and using the opportunity to test again, or, in the case of a true positive, provide support in encouraging the use of the Quit For Life® Program for assistance in quitting.

Note: Self-reported quit rates are highly correlated with the results of biochemical verification tests such a cotinine tests. Alere Wellbeing does not recommend using cotinine testing to verify quit rates.

If you missed the popular March 13 webinar  Best Practices for Premium Differentials in Tobacco Cessation, sign up for the next presentation on March 20 at 11am PDT. Yuki and a panel of human resources professionals experienced in premium differentials from Sherwin-Williams, Family Dollar, and WellPoint will share lessons learned and best practices. Visit Clear Insights to register.

Read Yuki’s blog post, Nicotine Testing for Employee Tobacco Use

Yuki Yang, Vice President of Client Services

Tobacco use remains the number one cause of preventable death and disease in the United States and costs employers an estimated excess cost of $21 per smoker, per day, or $7,874 per year. What was once a debate is now an accepted fact: employers must take an active role in helping their tobacco users quit successfully.

Healthier workforces mean better productivity and fewer medical expenses, and according to the Centers for Disease Control and Prevention, an evidence-based tobacco cessation program is one of the only employer benefits with a proven ROI. If you already have a tobacco cessation program in place at your organization, you may wonder how to effectively drive participation. Will offering incentives discriminate against nonsmoking employees, reward smokers for unhealthy behaviors, or negate the ROI for the program?

Alere Wellbeing has found that employers successfully increase participation in wellness programs when they reward healthy behaviors throughout the course of the program rather than focusing on the end result. By implementing an approach that includes an evidence-based program, is supported by a positive environment, and is led by a team that anticipates the future, you will find that offering incentives can promote positive behavior change, positively impact your bottom line, and improve your employee relations.

What motivates people to change?

People are innately motivated by the possibility of rewards, and a person’s motivation increases with confidence in his or her ability to perform the task at hand. Most smokers say they want to quit, but many who have tried to quit in the past have not succeeded. This leads to a lack of confidence and a decrease in motivation to try again. In order to promote lasting behavior change, you must provide the kind of environment that encourages and rewards healthy choices rather than punishes those caught in an addictive cycle.

• Increase motivation with knowledge. Tobacco use is an addiction that hits a smoker on three fronts – he is addicted physically, behaviorally, and emotionally. Helping smokers understand the kind of battle they are up against – and offering the tools to help them face each part of this battle – will give smokers more confidence in their ability to quit successfully. Nonsmokers will benefit from reminders that tobacco use is an addiction and that smokers should be encouraged rather than vilified.
• Build confidence through practice. Practicing new behaviors in situations that used to involve tobacco builds confidence in a smoker’s ability to change.
• Reframe destructive thoughts by developing cognitive skills. Developing new ways of thinking about tobacco use by reframing incongruous thoughts prepares smokers to make rational choices rather than giving way to addictive behaviors.
• Emphasize tangible and intangible rewards. Smokers who quit will experience tangible rewards such as better health and financial gain (this will be especially true if you offer a premium differential, which I will address in upcoming blog posts). Through an effective program, they may also experience intangible benefits such as happiness, positive competition, and reduced stress. Remind your employees of the benefits they will receive—those they will acquire from you as well as those they will achieve for themselves.

Join Yuki for the next Clear Insights webinar, Best Practices for Premium Differentials in Tobacco Cessation, March 13 and March 20 at 11am PST. Yuki and a panel of human resources professionals experienced in premium differentials from Sherwin-Williams, Family Dollar, and WellPoint will share lessons learned and best practices. Visit Clear Insights to register.

Erin Thompson Curlett, Senior Content & Social Media Marketing Manager

Today we are excited to announce our industry-leading tobacco cessation program, Quit For Life®, is now available in Spanish, removing language as a major barrier to quitting for Spanish speakers.

Quit For Life® in Spanish, available to employers and health plans, features phone-based coaching with a native Spanish-speaking Quit Coach®, integrated with Web Coach®, the most innovative and advanced online learning and social support community available for tobacco users. Clients receive dedicated account management, transparent reporting, and a customizable promotions package including a website (www.quitnow.net) and more than 100 materials and emails in Spanish.

Nearly 15 percent of our service delivery staff has been trained to support Spanish-speaking participants, including registration intake specialists, Quit Coaches, and supervisors. Quit For Life® has the highest standards for coaching in the industry, including ongoing mentoring, training, and evaluation.  As such, Spanish Quit Coaches must graduate from 12 weeks of immersive training on clinical protocols and tobacco cessation coaching, and 4 weeks of training on cultural and dialect differences, dosing regimens for medication, and symptomology. We recruit staff with a background or education in counseling, addiction studies, community health education, or social work. Our Spanish-speaking Quit Coaches are native speakers hailing from countries like Puerto Rico, Mexico, Colombia, and more.

Read the press release about Quit For Life® in Spanish

More information about Quit For Life® can be found at www.alerewellbeing.com or by emailing wellbeingsales@alere.com.

Reed Dunn, Senior Recruitment Marketing Manager

Sheila Woods was no stranger to quitting tobacco.

A smoker for more than three decades, Sheila had tried to quit several times in the past. But she always returned to tobacco.

“I decided smoking was getting in the way of being a mother,” the mom of three said of her earliest quit. “I quit for eight years. I just did that cold turkey, but I always enjoyed the smell of cigarette smoke. Eight years later, we were at a concert outdoors, and a friend of mine was smoking …”

Needless to say, Sheila found herself reaching for cigarettes, again.

When Steelcase began offering the Quit For Life® Program to eligible employees, Sheila, an Operations Manager based in Grand Rapids, Mich., enrolled in the company’s free benefit.

“For the most part, it was really society and my feeling that smokers are just outcasts more and more so everywhere,” Sheila said of her decision to quit this time. “The state of Michigan also had banned smoking indoors.

“It’s one thing if you’re in Florida and have to smoke outside. But when you’re in Michigan in January, it’s a different thing.”

There were several other factors, including the upcoming wedding of her oldest daughter, a tobacco surcharge Steelcase was implementing on her insurance plan and other external pressures, that led to her ultimate decision to join the program.

“I started smoking at 16 to be cool and in the in crowd,” she said. “At 49, I realized I’m one of the only ones smoking.”

Sheila set a Quit Date for April 12, 2011, and she has been tobacco free since that date.

“That week, I was really having a bad week,” she said of her quit week. “I called the Coaches and asked what other kinds of support there was, and they told me about the gum and nicotine patches.”

She reached out to get nicotine patches, which are offered as part of the Quit For Life Program offering from Steelcase. Still, the quit wasn’t easy.

“I went through a month of hell,” Sheila said. “The phone calls were really what kept me going. They were a lot more helpful and valuable to me than I thought they would be.”

The Quit For Life Program’s Quit Coaches® had helped Sheila set a Quit Date that was specific to her individual tobacco use and desire to quit. They also were there for her during the difficult weeks that followed her quit.

“I did not look forward to those phone calls, but in retrospect they were probably the best part of me quitting.”

Having successfully quit using the Quit For Life Program, Sheila has even inspired a couple of other Steelcase employees to jump on board and enroll in the program. She said the program made a big difference in her quit success this time.

“I would definitely advise anybody to go through the program,” she said. “I did find it to be extremely helpful. … Look at all of the things available through the program and be prepared when the date comes.”

To enroll in the Quit For Life® Program and gain access to Quit Coaches and free nicotine patches or gum to assist with your quit, call 1-866-QUIT-4-LIFE (1-866-784-8454), or visit quitnow.net. For helpful quit tips, preparation advice, and to meet others like you, visit the Quit For Life® Facebook Page.

Erin Thompson Curlett, Senior Content & Social Media Marketing Manager

We want to extend a big thank you to our latest Clear Insights webinar presenter, Ron Goetzel, Research Professor and Director at Emory University's Institute for Health and Productivity Studies and Thomson Reuters’ Vice President of Consulting and Applied Research. The recording of his presentation, The Economic Impacts of Obesity in the Workplace - And, What You Can Do About It, is now available on Clear Insights. 

Much of the rise in skyrocketing healthcare costs today can be attributed to the increase in chronic diseases such as diabetes, hypertension, pulmonary conditions, and chronic back pain. Why the increase in disease prevalence? One major cause is the epidemic rise in obesity rates among Americans: today, two-thirds of adults are overweight; one-third is obese. Many of today’s most commonly prescribed drugs are for obesity-related conditions, and as such, obese individuals spend two to four times more on prescription medications than adults who are non-obese. Add this to associated losses in productivity, absenteeism, and presenteeism, and it’s an equation that equals financial trouble for many organizations.

Yet studies have shown that in many cases, weight loss significantly reduces healthcare and medical expenditures. And clinical evidence has shown that even a 5-10% weight loss is enough to reap significant health benefits and reverse the progression of certain chronic conditions. The question for employers is how to help their workforce take the weight off – and keep it off – in a healthy way.

In The Economic Impacts of Obesity in the Workplace - And, What You Can Do About It, Dr. Goetzel discusses the rising health and productivity-related expenditures that employers face, the top 10 most costly chronic conditions, and the role obesity plays in creating or exacerbating these conditions. He also shares data from several large U.S.-based research studies conducted at corporations like PepsiCo and Dow Chemical and highlights success factors for employee weight loss and overall worksite health.

Visit Clear Insights to download free white papers and webinars to learn strategies for building a healthy workforce and improving your ROI.

Liane Claassen, Quit Coach, Service Delivery:

Alere Wellbeing is a healthy behavior company. It thrives to help people live healthier lives. Alere Wellbeing also likes to walk the talk by offering quarterly challenges based around health to its employees. This quarter we have the chance to complete the Healthy Harvest Challenge. The goal is to increase daily consumption of fruit and veggies, and if we are lucky we might win a prize. I know I will be lucky once I’m aware of the steps I have to take to increase my daily consumption. I feel balanced and well when I eat fruits and veggies, and drained and depressed when I don’t, and yet I favor cheese and butter over vegetables or fruits.

My goal is to eat 3 servings of each per day. I just finished my first week of the challenge and consumed roughly 25 servings of fruit and veggies during that week. Last night, I had consumed 3 servings of fruit over the course of the day, but no veggies. The plan was to share a beet dish with my husband, but then watched him eat it all without interrupting him. I ended up eating more cheese w/ bread and butter instead, and while I was savoring the melted butter on my toast and the yummy cheese that went so well with it, I felt guilty but remained silent nevertheless. Well, it’s called a challenge for a reason, isn’t it!

So, I started to analyze myself. If I know my needs, I can start planning for them. What I noticed about myself is that I don’t like raw vegetables. I also noticed the servings have to be ready to eat by the time I want to eat them. So, putting an orange on my desk won’t work because I’d have to peel it first and that’s messy. One of the main insights I gained is that I have to be on some kind of a schedule where I eat fruit or veggies in the same situation.

Here is what I have come up with:

• The rule is to have fruit/ and or veggies with each meal or snack. A serving is mostly ½ cup, whether that’s fruit or vegetables.
• Frozen ready- to- eat fruits and veggies are my best friend. This allows for no more excuses as I don’t need to prepare anything! I have frozen fruit with my cereal in the morning. I add a serving of veggies to each canned soup I eat. You get the picture. All you need is a microwave and a bunch of different bags for variety. To add flavor I usually add a little olive oil with salt and pepper or herbs if I eat veggies by themselves.
• I also get fresh fruit and veggies delivered once a week. I cook all the vegetables, and sometimes some of the fruit, all on the same day of the delivery. Now I have tasty dishes ready in the fridge. I can use them as part of the main meal, or as little snacks in-between.
• I eat fruits or veggies for breakfast, lunch, and dinner. In addition I started to put a serving of fresh cut fruit on my desk. If I haven’t eaten it by the end of my shift I’ll eat it then.
• I won’t deprive myself. If I feel like having something like cake, then I have fruit with it as well. If I feel like having something like cheese or meat, then I have vegetables as well.
• When I order in the restaurant I always order a vegetable dish, a bowl of fruit or fruit juice (if it’s 100%) along with my dish. If I order coffee, I also order something healthy, like a banana.
• When company comes over for a visit I cut up some fruit and present it on a plate.
• I’m trying to change the way I look at dinner. Instead of saying “We are having steak tonight” I might say “We are having kale and potatoes with steak tonight.” The proportions on the plate will be mainly veggies and grains plus some steak.

I’m feeling pretty accomplished about this and know I can easily incorporate these rules into my life. The pumpkin ice cream in the fridge is calling to me...I bet those frozen mangos next to the ice cream go well with it.