WASHINGTON--Although smoking is one of employers' priority employee health issues, ranked third behind high blood pressure and obesity according to a National Business Group on Health survey, just 24% of employers offer any coverage for smoking cessation programs and only 4% provide truly comprehensive coverage.

But smoking cessation programs are one of the most cost-effective benefits employers can offer, tying with aspirin therapy for heart disease prevention and childhood immunizations, according to research conducted by the U.S. Centers for Disease Control and Partnership for Prevention, a Washington-based organization that, among other things, promotes the use of evidence-based disease prevention and health promotion policies.

Helping employees to quit smoking will also increase productivity when smokers no longer take cigarette breaks, according to a survey conducted by the NBGH that was released at the Joint Forum on Health, Productivity and Absence Management cosponsored by the NBGH and the San Francisco-based Integrated Benefits Institute that was held Nov. 28-30 in Washington.

The survey, which included responses from 500 employers and 500 employees who smoke, found that nearly half of employees reported taking between three and six smoking breaks a day, and more than two-thirds of those reported breaks lasting between five and 15 minutes.

That means "employees can be out on smoke breaks up to nine weeks" a year, said Ron Finch, vp of the NBGH. "That's 16% of the work year, or one day a week."

But Mr. Finch suggested that, based on his personal experience as a former smoker, the employee-smokers responding to the survey may have underestimated the duration of their cigarette breaks, leading to even more lost time.

The NBGH survey, conducted between Oct. 24 and Nov. 12, also found that employers are not doing enough in other ways to encourage their employees to kick the habit.

For example, even though most employers--67%--have smoke-free workplace policies, they are not perceived by employees as effective deterrents to smoking.

Mr. Finch cited the survey findings that around three out of four employees--78%--whose employers have taken steps to establish a smoke-free workplace said that such a policy was not effective in motivating them to quit.

To encourage more of its employees to quit, Marriott International Inc., whose properties became smoke-free on Oct. 16, introduced a smoking cessation program last month that is available at no charge to all of its employees and dependents who are at least 18 years old and who are enrolled in its health plans, according to Karen Graham, manager of health plans for the Washington-based hotel chain.

The Seattle-based Group Health Cooperative also announced during the forum that it is introducing a tobacco-free policy beginning Jan. 1 that will include offering a comprehensive smoking cessation program for employees and dependents.

Both employers, who addressed their new nonsmoking policies and benefit programs during separate sessions held during the NBGH/IBI's Joint Forum, have chosen to adopt the benefit structure recommended by the CDC, which includes at least four counseling sessions of at least 30 minutes each; both prescription and over-the-counter medications; coverage for at least two quit attempts each year; and limited or no copayments.

Because tobacco dependence is an addiction, it should be treated like any other chronic disease, said Corinne Husten, chief of the epidemiology branch of the Office on Smoking and Health at the CDC. That is why the CDC recommends that employees be allowed to re-enroll in smoking cessation programs if they don't succeed at quitting the first time, she said.

The CDC also recommends no or low copayments because "cost-sharing is a huge barrier to quitting," Ms. Husten added.

Ms. Husten said that according to a study by the Journal of Health Promotion, only 24% of employers offer any type of smoking cessation benefits to employees, and, of those, just 4% offer benefits at the level that the CDC prescribes.

"If you're looking at maximizing your health care investment as an employer, this is where you should put your investment," said Garry Lindsay, senior fellow and director of business partnerships at the Partnership for Prevention.

He said that the Partnership has developed a scoring system that has determined smoking cessation programs tie with daily aspirin use and childhood vaccinations in cost-effectiveness.

To demonstrate the cost-effectiveness of providing such benefits, the CDC and other organizations have developed a return on investment calculator that employers can use online at www.businesscaseroi.org, she said.

The NBGH also is advocating the CDC's smoking cessation program recommendations in its new employer Purchasers Guide for health benefits, according to Mr. Finch. The guide is available online at www.businessgrouphealth.org.