When it comes to tobacco use, our nation has come a long way. Between 1965 (when the first US general’s report came out) and 2000, rates dropped rapidly from almost 45% of American adults who smoked to approximately 25% in 2000 (Centers for Disease Control and Prevention).  However, since 2000 rates have steadied out – at about 19.3% as of 2010. Smoking is still costing the US more than it can afford. Smoking costs US businesses $97 billion dollars each year in productivity losses alone (Centers for Disease Control and Prevention, 2008).

People smoke for a number of reasons, including relief from stress or other discomforts, distraction, enjoyment, a concentration aid, social reasons, or for added help in weight management. Whatever the motivation may be that leads to smoking, the result is always the same- addiction. Quitting smoking is never as simple as starting.

Motivation plays a key role in quitting, and often is the predictor of success. Motivation behind behavior change can either be intrinsic or extrinsic. An extrinsic motivator is something external to the individual that is spawning the change. These tend to be incentives or punishments offered by a separate party. Extrinsic motivators, particularly with tobacco cessation, have not been associated with success. Intrinsic motivators are more effective in generating behavior change, as an intrinsic motivator would be internal and have value to the individual. For example, a mother may have a personal reason to lose weight such as being able to follow their toddler up and down the stairs.

With the knowledge that incentives and punishments may not be the most effective route to get employees to quit smoking, employers need to find another way to reach their employees. Programs often rely on incentives to increase awareness and participation. Incentives can still be used in this way for smoking cessation programming, however, it is important to remember their limitations and that there is no evidence that incentives actually increase quitting rates. Reasons for this may be linked to Prochaska’s[1] stages of change theory in which individuals are divided into five separate stages (pre-contemplation, contemplation, preparation, action and maintenance) describing their readiness to change a behavior. Current smoking cessation programs are successful in moving individuals already in the action stage through the behavior. However, these programs have not yet found a way to be successful in generating long-term quitting in those in the pre-contemplation, contemplation and preparation stages.

Some employers are turning to policies to get their employees to quit smoking. Again, just like with incentives, policies represent an extrinsic motivator for employees and may not generate long-term change, or drastically changing the health status and costs of the organization.

In order to generate not only immediate, but indefinite behavior change in smokers programs need to focus on the individual and provide support (Cochrane Collaborative Review). Along with policies, employers need to review what benefits are available for employees. The more access employees who are contemplating or attempting quitting have to various sources of support (nicotine replacement therapy, group programming, individual counseling etc.), the more likely they are to succeed. Employees should be educated on the policy and why it exists, and encouraged to take advantage of the resources provided to help them. Focusing on other components of health, such as physical activity, nutrition and social support also strengthens a program as well as helps to prevent relapse. Smoking is not an isolated behavior, and letting employees know their overall health status is cared about will contribute to their success, as well as to an organization’s positive and supportive environment.

[1] Glanz, K., F. Marcus-Lewis, and B.K. Rimer, editors (2008).  Health Behavior and Health Education, (4th  edition).  California: Jossey-Bass Publishers.

 Kay Monks

Kay is a senior at American University in Washington, D.C, where she is enrolled in the Health Promotion Education program. Kay has been an intern with AdvancingWellness since early 2011.