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Working With Employees for Nutrition & Smoking Cessation

IBI member Caterpillar is the largest maker of construction and mining equipment, diesel and
natural gas engines, and industrial gas turbines in the world (with over 100,000 employees
worldwide). Among its health-promotion initiatives are programs involving nutrition at the
workplace and smoking cessation. Both programs are under the direction and responsibility
of Michael L Taylor, M.D., Caterpillar’s Medical Director for Health Promotion.
Dr. Taylor’s basic philosophy for his health-promotion team is to bring health programs to
Caterpillar employees using a carrot not a stick. The experience gained and lessons learned
by Caterpillar in working with nutrition and smoking cessation, over a number of years,
can offer other employers a running start – a key goal of IBI’s Employer Insights series.
Nutrition: Caterpillar’s health promotion program, branded as “Healthy Balance,”
assumed control of its food service initiatives four years ago. The program, offered in
partnership with supplier Eurest, is available in all of Caterpillar’s large plants throughout
the U.S. but not in some of the smaller ones, where there is no cafeteria.
The “Healthy Balance” food service program includes the following features:
¾ Nutrition information – a key communications initiative brings knowledgeable
consumer choice to Caterpillar workers. Nutrition information is available on the serving line and is available for all foods offered in the cafeteria. ¾ Differential pricing – Caterpillar supports healthy choices with healthy items priced lower than traditional foods, and relies on consumer choice. For example, Garden Burgers are priced lower than beef burgers. A variety of healthy foods are offered through the “Lunch for Less” program. A fruit cup is available for 99 cents and a health-food plate is $1.99 compared to much higher pricing for a burger and fries. Caterpillar offers the program at a modest subsidy for healthy choices. ¾ Communications – In addition to nutrition labeling and price differentials, Caterpillar relies on a strong employee communications program, with announcements in internal company materials, on the web site, and in the dining centers. Caterpillar’s nutrition consciousness also extends to healthy choices in on-site vending machines. Caterpillar’s vending machine supplier partner is Compass, the parent of food service partner Eurest and the largest vending machine operator in the U.S. Initially, Caterpillar set the direction and philosophy for implementation, and then Compass became an enthusiastic partner. Compass now pushes its snack suppliers, like FritoLay, to produce and offer more choice in healthier products. Today, the Compass website touts its nutrition efforts and healthy choices. The vending machine program includes the following: ¾ Nutritional information – As with food services, nutritional information is available before purchase and is posted on the outside of each machine. ¾ Healthy choices – 20% of all items in the vending machines are low-fat / heart- healthy options to the traditional food choices that are also available. ¾ Facilitating a healthy choice – Healthy snacks are segregated from the less-healthy food in the machines to make a healthy choice easier. The vending machines also offer price differentials for healthy foods
Measurement - Food service offers real-time tracking of what is being sold, so Taylor and
his team can readily measure the success of many of their initiatives. For example, the
cafeteria sold 500 garden burgers a month before differential pricing was offered.
Afterwards, the cafeterias sold 2,500 per month, a five-fold increase achieved by making
Garden Burgers a better value.
Smoking cessation: Caterpillar products and components are manufactured in 300
facilities, in 40 countries around the globe. The logistical and cultural challenges make
Caterpillar’s global smoke-free campus goals especially ambitious.
Caterpillar contracted with Free & Clear to implement their smoking cessation program
and introduced it to employees in 2002. The program includes a number of important
components:
¾ Readiness to quit – Caterpillar doesn’t offer the program to employees until they are
ready to quit. This assessment is done in a straight-forward manner: When employees state in a twice-a-year health risk assessment (HRA) that they are ready to quit, Caterpillar makes the program available. Studies support this approach,1 and Dr. Taylor believes it has resulted in a more effective program at Caterpillar. In addition, the program assesses readiness to quit through focused communications initiatives and through nurses in-serviced on the program. When an employee decides to quit, they call a Caterpillar customer service representative, who confirms eligibility and routes them to the cessation program. ¾ Program is free to participants – Caterpillar’s approach is based on a peer-reviewed study2 that suggests that the most successful programs remove all financial barriers to participation. Dr. Taylor had some initial pushback from the “entire implementation team.” After seeing the results, however, the “free” approach garnered buy-in. ¾ Free counseling and medication is provided within the program – All participants are offered the opportunity to take advantage of one year of free counseling. Based on counseling results, participants with severe nicotine addiction may choose either a free nicotine patch or gum or may take Zyban, a medication that works in the central nervous system to suppress desire for smoking. Caterpillar ships an 8-week supply of the patch or gum to the participant’s home. Zyban is provided with no co-pay for those in the standard group insurance plan, but only if they are in the Free & Clear program and receive coaching. ¾ Corporate policy changes support the program – Caterpillar made several corporate policy changes to support the smoking cessation program. The company banned smoking inside buildings in the U.S. in 2006 and globally in 2007. It will ban smoking on the Caterpillar campus altogether in July 2008 in the U.S. and globally in 2009.
An additional boost for the program came on January 1, 2008 when the state of Illinois
went smoke free. The mandate, in Caterpillar’s home state, started pushing participation
in Caterpillar’s program two months before it went into law. Caterpillar averaged 54
enrollees per month through the first 10 months of 2007 but averaged 100 enrollees in
November and December before the January 1 effective date.
Measurement - All employee participants in the smoking cessation program are included
in a study group, and Caterpillar monitors their results. In the five years from 2002
through 2006, 2,000 employees have participated – reaching 20% of smokers company-
wide. The five-year quit rate is 34%, including those that completed the program by the
end of 2006.
Key Lessons:
¾ Healthy food choices can be both a price and value proposition.
¾ Modifying corporate policy to support health initiatives highlights the company’s
commitment to health and aligns the corporate culture with health incentives. ¾ Removing the financial barriers to employee participation can play an important part ¾ HRAs can help you target health initiatives. Caterpillar gets 91% participation in its HRA program by offering a generous health plan premium reduction premised on completion of the HRA. It uses the results pragmatically – such as determining effective candidates for smoking cessation efforts. ¾ To take the next step and measure health-related lost time, companies must build on trust fostered by successful programs like these to improve employee acceptance of self-report surveys. Even with clear firewalls around survey information, there still may be employee hesitance to participate in surveys that measure absence and presenteeism, like the HPQ or WLQ. ¾ Caterpillar has five years of data – the longest of any Free & Clear client. Maintaining and tracking data with a consistent measurement tool, over time, demonstrates when positive changes in tobacco use are long-term and not temporary. ________________________ 1 DiClemente, Prochaska, Fairhurst, Velicer, Velasquez and Rossi: The process of smoking cessation: an analysis of precontemplation, contemplation, and preparation stages of change. J Consult Clin Psychol, 1991; 59:295–304 2 Curry, Grothaus, McAfee and Pabinlak: Use and Cost Effectiveness of Smoking Cessation Services under Four Insurance Plans in a Health Maintenance Organization. New England Journal of Medicine, 1998; 339:673-679

Source: http://www.disabilitycanhappen.org/employer/docs/March_2008_Research_Insights.pdf

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