Researchers at the University of California San Francisco recently analyzed that risk. They found that among those with the coronavirus, the risk of disease progression in current or former smokers was nearly double that of non-smokers. And, when the disease worsens, current or former smokers had more acute or critical conditions and higher rates of death.

Smoking and respiratory disease have long been linked. By suppressing the immune system and damaging lung tissue, smoking makes it more difficult for the body to fight off respiratory infections. Smokers' lungs may be irritated and fragile, potentially making them more susceptible to lung infection, including COVID-19. Vaping, which the Surgeon General says is an "epidemic" among youth, may also be linked to increased risk of respiratory damage.

In light of the pandemic, finding ways to help employees and family members who wish to quit has taken on new urgency for employers. But addressing this issue won't be easy. Tobacco quitline coaches report that, while callers say they want to stop since they fear that smoking puts them at high risk of contracting COVID-19, quitting has been a struggle because they feel isolated at home and highly stressed.

Best practices not followed

While the rate of smoking has declined in recent years, an estimated 34.2 million (13.7%) U.S. adults aged 18 or older still smoke, according to the 2020 Surgeon General's Report on smoking. The report contains some good news:

• More than two-thirds of smokers say they want to quit
• More than half try to quit smoking every year
• More than three out of five adults who have ever smoked cigarettes have quit

Yet, the report points out, less than one-third of those attempting to quit use cessation medications approved by the U.S. Food and Drug Administration or behavioral counseling to support those attempts. Evidence-based treatments, such as nicotine replacement medications and behavioral methods – especially when used in tandem – are often successful and cost-effective, according to the report.

Effective cessation programs use a wide range of tools, including:

• Proactive outbound coaching calls with trained behavioral change experts
• Easy access to nicotine replacement patches, gum and lozenges
• Online learning community and expert-led online courses
• Progress and cost-savings trackers
• Secure email messages
• Mobile texting and "urge management" tools

Combination therapy

Some employers have achieved significant results with cessation programs offering combination therapy – adding two weeks of nicotine gum with eight weeks of patches. One manufacturer offered this benefit to employees who smoked nine or more cigarettes daily or chewed two or more tins of spit tobacco per week. The result: 40% increase in program enrollment in the first four months following launch and a quit rate of 56% compared with 48% for employees not using combination therapy.

Customize programs

Cessation programs should not be framed as one-size-fits-all. Tobacco use persists among vulnerable populations who may require unique approaches to quit. For example, 34% of those with behavioral health conditions, 29% of veterans, and 20% of lesbian, gay and bisexual persons use tobacco – well above rates for the general population. Tobacco prevention and cessation efforts should focus on the particular needs of these priority populations.

Behavioral health conditions

The pandemic is exacerbating emotional and social health. For the first time, a majority of adults (53%) say that stress and worry has had a negative impact on their mental health. This decline in well-being, combined with tobacco use, may put smokers at increased risk of having severe COVID-19 symptoms.

Nearly half of quitline callers have at least one mental health condition, and quit rates for these callers are roughly 10 percent lower on average than for other callers. 9 Many people with behavioral health conditions want to quit smoking but may face extra challenges in doing so.

Smokers with behavioral health conditions may benefit from programs providing intensive support including:

• Assessment of the severity of their behavioral health condition
• Combination nicotine replacement therapy with extra weeks of patches and gum or lozenges
• Additional phone calls with trained coaches
• Communication with the participant's health provider

A seven-month pilot study conducted of smokers with at least one behavioral health condition enrolled in an intensive cessation program showed promise. The quit rate among participants was 30%, compared to 21% for smokers participating in the standard cessation program. 10

During these stressful times, benefits managers should pay close attention to their employees who smoke. Providing evidence-based, targeted tobacco cessation programs – backed by robust communications and multi-modal support – can empower and motivate them to quit.

Seth Serxner, PhD, is chief health officer at Optum.

Read more: 

• Americans smoking less, but diabetes and obesity are increasing
• Can employers help shrink smoking's income gap?
• Heroin, tobacco and alcohol use all declining