Introduction
Background
Model Program Guidance

• Screen participants
  
• Provide information on nicotine replacement therapies
  
• Use a variety of clinicians in the program
  
• Offer group supportive counseling, individual counseling and peer support
  
• Include appropriate counseling and supportive elements
  
• Provide relapse prevention sessions and information
  
• Offer agency-wide media campaign

INTRODUCTION

The U.S. Office of Personnel Management supports and encourages agency authorized programs aimed at health promotion and disease prevention, including smoking cessation programs. According to reports issued by the Surgeon General, smoking is the chief avoidable cause of death in our society. Programs designed to help employees stop smoking are in the best health interests of those Federal employees who smoke and those who do not smoke. These programs may also contribute to improved organizational performance and productivity.

BACKGROUND

On August 9, 1997, the President issued Executive Order 13058 establishing a smoke-free environment for Federal employees and members of the public visiting or using Federal facilities. In Section 4 of the Executive Order, the President encouraged agencies "to use existing authority to establish programs designed to help employees stop smoking." A decision by the Comptroller General of the United States (B-231543 dated February 3, 1989) held that under 5 USC §7901, Federal agencies have the authority to utilize appropriated funds to pay the costs incurred by employees participating in agency-authorized smoking cessation programs. The decision held that because smoking is a major contributing cause of illnesses such as cancer, coronary disease and emphysema, smoking cessation programs are "preventive" in nature and authorized under 5 USC §7901(c)(4). This authority can also include payment for nicotine replacement therapy (use of the nicotine patch or nicotine gum) when purchased as part of an agency's smoking cessation program.

MODEL PROGRAM GUIDANCE

This model program is based upon recommendations by the Agency for Health Care Policy and Research (AHCPR) of the U.S. Department of Health and Human Services' Centers for Disease Control and Prevention issued in April 1996. These recommendations were developed as part of a "Quick Reference Guide for Smoking Cessation Specialists," and can be used by agency planners in the development of their smoking cessation programs or in assessing the effectiveness of potential program providers. Whether agency-developed programs are administered internally (e.g., by a coordinated effort involving the agency's Health Unit and the Employee Assistance Program Counselor) or externally (by contracting with a smoking cessation program provider), agencies are urged to follow these recommendations in the development of their programs.

A. MODEL PROGRAM COMPONENTS

• Screen participants using Health Unit staff, including a limited physical examination

Except in special circumstances (i.e., in the presence of serious medical precautions), every smoker should be offered nicotine replacement therapy (NRT). The nicotine patch and nicotine gum are particularly useful in helping smokers quit. In the instance of relapse, a careful assessment should be made to determine if incorrect use of NRT contributed to the relapse, and employees should be encouraged to try again.

*NOTE: According to Agency for Health Care Policy and Research (AHCPR) guidelines on smoking cessation programs, nicotine replacement therapy is one of the elements in a cessation program that is particularly effective. The guidelines state that either a nicotine patch or nicotine gum doubles the rate of quitting success in a cessation program. Employees may also wish to discuss with their physicians the use of nicotine inhalers, nicotine sprays, or bupropion HCL (sustained release tablets); these medications were not avialable when the AHCPR guidelines were published, but have been approved by the Food and Drug Administration (FDA) for smoking cessation.

• Use a variety of clinicians in the program

Multiple types of clinicians should be used in intensive smoking cessation programs. One strategy would be to have a medical/health care clinician deliver messages about health risks and benefits, and nonmedical clinicians deliver psychological or behavioral interventions.

• Offer group supportive counseling, individual counseling and peer support

Individual or group counseling programs are helpful. The AHCPR guidelines panel found a direct relationship between the intensity of treatment and the likelihood for success. Because of evidence of a strong dose-response relation, the program should include the following elements:

Session length - at least 20-30 minutes in length.

Number of sessions - at least 4-7 sessions




Length in weeks - at least 2 weeks, but preferably up to 8 weeks.

• Include appropriate counseling and support elements

Interventions should include problem solving/skill training content as well as clinician-delivered social support for quitting. For example, common elements of problem solving/skills-training treatments would be:

(1) recognition of danger situations (e.g., being around other smokers, being under time pressure, getting into an argument, experiencing urges or negative moods, or drinking alcohol);
(2) coping skills (e.g., learning to anticipate and avoid danger situations, learning cognitive strategies that will reduce negative moods, accomplishing lifestyle changes that reduce stress, improve quality of life, or produce pleasure); and
(3) basic information (e.g., the nature/timecourse of withdrawal, the addictive nature of smoking, or the fact that any smoking (even a single puff) increases the likelihood of full relapse).

Common elements of supportive smoking cessation treatments would be:

(1) encourage the participant in the quit attempt; (2) communicate caring and concern;
(3) encourage the participant to talk about the quitting process; and
(4) provide basic information about smoking and successful quitting.

Provide relapse prevention sessions and information

Most relapses occur soon after a person quits smoking, although some people relapse months or years after the quit date. Therefore, specialists should work to prevent long-term risks of relapse. These interventions can occur during treatment sessions or during follow up contacts and should: (1) reinforce the employee's decision to quit; (2) review the benefits of quitting; and (3) assist in resolving any problems related to quitting.

• Offer agency-wide media campaign, including printed information, notices on bulletin boards, participation in the "Great American Smoke Out" (sponsored annually by the American Cancer Society, usually in November)

B. CHECKLIST FOR ASSESSING A GROUP CESSATION PROGRAM

NOTE: Providers should be carefully screened before contracting for their services or referring employees. The following checklist, provided by the Office on Smoking and Health of the U.S. Department of Health and Human Services, can be used for screening such services.

Page updated 28 June 1999