Ringen Knut, Anderson Norman, McAfee Tim, Zbikowski Susan M, Fales Donald
Stoneturn Consultants, Seattle, Washington 98166, USA.
Am J Ind Med. 2002 Nov;42(5):367-77. doi: 10.1002/ajim.10129.
Taft Hartley Funds provide group health care coverage for 10 million union workers as well as their dependents in industries such as construction and transportation. The adult smoking rate in these populations is estimated at approximately 40%, therefore, these funds include 9 million adult smokers. The absence of evidence demonstrating the effectiveness of smoking cessation programs has kept Taft Hartley Funds from investing in smoking cessation benefits.
A prototype for Taft Hartley Funds consistent with the Federal Clinical Guidelines for Smoking Cessation was designed and implemented in a pilot demonstration in the Carpenters Health and Security Trust of Western Washington. Participants chose a 1-call or more intensive 5-call smoking cessation counseling plan provided by the Group Health Cooperative's Free and Clear program. Medications were limited to the nicotine patch, nicotine gum, and Bupropion. Assessment of outcomes was performed by Free and Clear through a telephone survey 12 months following the enrollment date.
Nine hundred thirty-five smokers participated in the program. This pilot evaluation covers 325 participants with at least 12 months since enrollment; 75% were male, the average age was 41.4 and 63% had smoked at least one pack per day for more than 20 years. Sixty-one percent selected 5-Call Counseling; 39% 1-Call. Seventy-five percent also used smoking cessation medications: gum, 4%; patch, 32%; Bupropion 21.5%; patch plus Bupropion, 15.7%. The point-prevalence-quit rates were: overall, 27.5%; 1-Call, 25.5%; and 5-Call, 28.9%. The cost of the program was $1025.28 per smoker who quit, or $11.78 per full-time equivalent employee covered by the Fund per year. The compounded savings in reduced lifetime tobacco-related medical costs for the participants who quit are estimated to be 15 times the cost of the program, yielding an annual return on investment of 27.6%.
These results strongly suggest that smoking cessation programs can be effective even in such hard-to-reach populations as itinerant building trades workers, provided that the program is designed to their needs and environment. Based on these findings, health plans need to consider whether they are at risk of violating their fiduciary duties if they fail to offer smoking cessation benefits.
塔夫脱-哈特利基金为1000万工会工人及其在建筑和运输等行业的家属提供团体医疗保险。据估计，这些人群中的成年人吸烟率约为40%，因此，这些基金涵盖了900万成年吸烟者。由于缺乏证据证明戒烟项目的有效性，塔夫脱-哈特利基金一直没有投资于戒烟福利。
在华盛顿西部木匠健康与安全信托基金的一项试点示范中，设计并实施了一个符合联邦戒烟临床指南的塔夫脱-哈特利基金原型。参与者选择了由团体健康合作社的“自由与清晰”项目提供的1次电话或更密集的5次电话戒烟咨询计划。药物仅限于尼古丁贴片、尼古丁口香糖和安非他酮。“自由与清晰”项目在登记日期后的12个月通过电话调查对结果进行评估。
935名吸烟者参加了该项目。这项试点评估涵盖了325名登记后至少12个月的参与者；75%为男性，平均年龄为41.4岁，63%的人每天至少吸一包烟超过20年。61%的人选择了5次电话咨询；39%的人选择了1次电话咨询。75%的人还使用了戒烟药物：口香糖，4%；贴片，32%；安非他酮，21.5%；贴片加安非他酮，15.7%。点患病率戒烟率分别为：总体，27.5%；1次电话咨询，25.5%；5次电话咨询，28.9%。该项目的成本为每位戒烟者1025.28美元，或基金覆盖的每位全职等效员工每年11.78美元。据估计，戒烟参与者在降低与烟草相关的终身医疗成本方面的复合节省是该项目成本的15倍，投资年回报率为27.6%。
这些结果有力地表明，戒烟项目即使在像流动建筑工人这样难以接触到的人群中也可能有效，前提是该项目是根据他们的需求和环境设计的。基于这些发现，健康计划需要考虑，如果它们不提供戒烟福利，是否有违反其信托责任的风险。
