Holly Reimer started smoking at age 14.

A friend brought a single cigarette to school and at recess they sneaked behind the ice skating rink to take a few puffs. She'd always loved the smell of her grandfather's cigarettes, so when she had the opportunity to try the real thing, she was excited.

That experience would lead to 32 years of smoking several packs a week.

But when her employer, Alaska Native Tribal Health Consortium, adopted a tobacco-free campus policy in 2006, she decided it was time to quit.

Alaska Native Tribal Health Consortium employee Holly Reimer quit smoking in 2006 with the help of a tobacco cessation program sponsored by her employer.

"I had just been made supervisor, and I thought I should probably set a good example for my staff," Reimer said.

She arranged a meeting with the tobacco users in her department and ANTHC's Tobacco Cessation Program. They talked about what methods would be best for each of them to successfully quit. Reimer landed on the prescription medication Chantix. Two weeks later, she smoked her last cigarette.

Tobacco-free workplaces

According to the 2015 Alaska Tobacco Facts update, 42 percent of Alaska Native adults and 19 percent of non-Native adults smoke. Vaping is on the rise for high school students, with 18 percent using e-cigarettes. To put that into perspective, just 11 percent of high schoolers are smoking traditional cigarettes.

However, smoke-free or tobacco-free campuses have risen in popularity in recent years. In addition to ANTHC, Providence Hospital, Alaska Regional Hospital, Alaska Airlines and University of Alaska Anchorage are all tobacco-free, the latter achieving tobacco-free status in November.

"We knew by implementing a tobacco-free campus, more people would make a quit attempt and are more likely to quit successfully," said Dana Diehl, ANTHC's Tobacco Prevention and Control program manager. "And as a health care provider, it's important we send this message."

Once the decision is made to go tobacco-free -- including everything from traditional cigarettes and cigars to smokeless tobacco and e-cigarettes -- many of the organizations start building resources for tobacco cessation. For UAA, that meant forming committees to help with implementation, education and cessation resources. Alaska Airlines and Providence no longer hire tobacco users; Providence applicants are screened for nicotine along with all other drugs. And all employees and patients of Alaska Native Medical Center are offered behavioral counseling and replacements -- like nicotine therapy and prescription medications -- to aid in quitting.

ANMC now screens all patients for tobacco use and offers an immediate referral to the tobacco treatment program if they want help to quit, no matter what brings them to the hospital.

Returns on investment

Eliza Muse, the program coordinator for the State of Alaska's Tobacco Prevention and Control Program, said there are a variety of benefits associated with putting steps in place to aid employees in quitting use of tobacco products.

"Each year, an employer can save $3,000 per employee in direct health care costs and lost productivity," Muse said.

That loss of productivity, Muse said, is seen in the form of sick days, because employees who smoke statistically take more sick days annually than non-smokers.

The cost per quit for smoking cessation interventions, ANTHC's Diehl said, ranges from a few hundred to a few thousand dollars, while the average cost for treatment of a single case of lung cancer can be more than $40,000.

A study published by the Department of Health Policy and Management at Emory University found that tobacco cessation treatment in the outpatient setting lowers health care costs within 18 months of quitting. Sustained quitters, the study found, cost $541 less per quarter than those who continued to smoke. And according to data from the State of Alaska's Division of Public Health, in 2012, tobacco use cost Alaska $370 million in direct medical expenditures and an additional $231 million in lost productivity.

Another cost saving measure for businesses would be disallowing smoking in bars and restaurants, said Muse. Allowing tobacco products in a business raises the fire insurance and liability costs.

The aftereffects

As for Reimer, she said her employer's investment in tobacco cessation resources has not only helped her save money on the cost of cigarettes, but has noticeably improved her quality of life.

Now she's able to exercise without getting out of breath or achy quite as quickly and doesn't feel like illnesses hit her lungs as much.

"I loved smoking," Reimer said. "I only tried to quit once back in the '90s, but my now ex-husband smoked and our friends also smoked, so it wasn't the right time. Then it was too hard. And quitting is scary; you don't want to feel like you might fail. But this feels good now."

This story was sponsored by Alaska Native Tribal Health Consortium, a nonprofit Tribal health organization designed to meet the unique health needs of more than 150,000 Alaska Native and American Indian people living in Alaska.

This article was produced by the special content department of Alaska Dispatch News in collaboration with ANTHC. The ADN newsroom was not involved in its production.